Retrospective Comparative Study of Side-by-Side and Stent-in-Stent Metal Stent Placement for Hilar Malignant Biliary Obstruction.
Aged
Cholangiography
/ methods
Cholestasis
/ diagnosis
Decompression, Surgical
/ adverse effects
Equipment Failure Analysis
/ statistics & numerical data
Female
Humans
Japan
/ epidemiology
Klatskin Tumor
/ complications
Male
Neoplasm Staging
Outcome and Process Assessment, Health Care
Pancreatitis
/ diagnosis
Postoperative Complications
/ diagnosis
Recurrence
Retrospective Studies
Stents
/ adverse effects
Hilar malignant biliary obstruction
Side-by-side deployment
Stent-in-stent deployment
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
10
12
2019
accepted:
17
02
2020
pubmed:
29
2
2020
medline:
5
2
2021
entrez:
29
2
2020
Statut:
ppublish
Résumé
In patients with unresectable hilar malignant biliary obstruction (MBO), bilateral metal stent placement is recommended. However, treatment selection between partially stent-in-stent (SIS) and side-by-side (SBS) methods is still controversial. Clinical outcomes of bilateral metal stent placement by SBS and SIS methods for hilar MBO were retrospectively studied in four Japanese centers. While large-cell-type uncovered metal stents were placed above the papilla in SIS, braided-type uncovered metal stents were placed across the papilla in SBS. A total of 64 patients with hilar MBO (40 SIS and 24 SBS) were included in the analysis. Technical success rate was 100% in SIS and 96% in SBS. Functional success rate was 93% in SIS and 96% in SBS. Early adverse event rates were higher in SBS (46%) than in SIS (23%), though not statistically significant (P = 0.09). Post-procedure pancreatitis was exclusively observed in SBS group (29%). Recurrent biliary obstruction rates were 48% and 43%, and the median time to recurrent biliary obstruction was 169 and 205 days in SIS and SBS, respectively. Other than a trend to higher adverse event rates including post-procedure pancreatitis in SBS, clinical outcomes of SIS and SBS methods were comparable in patients with unresectable hilar MBO.
Sections du résumé
BACKGROUND
In patients with unresectable hilar malignant biliary obstruction (MBO), bilateral metal stent placement is recommended. However, treatment selection between partially stent-in-stent (SIS) and side-by-side (SBS) methods is still controversial.
STUDY
Clinical outcomes of bilateral metal stent placement by SBS and SIS methods for hilar MBO were retrospectively studied in four Japanese centers. While large-cell-type uncovered metal stents were placed above the papilla in SIS, braided-type uncovered metal stents were placed across the papilla in SBS.
RESULTS
A total of 64 patients with hilar MBO (40 SIS and 24 SBS) were included in the analysis. Technical success rate was 100% in SIS and 96% in SBS. Functional success rate was 93% in SIS and 96% in SBS. Early adverse event rates were higher in SBS (46%) than in SIS (23%), though not statistically significant (P = 0.09). Post-procedure pancreatitis was exclusively observed in SBS group (29%). Recurrent biliary obstruction rates were 48% and 43%, and the median time to recurrent biliary obstruction was 169 and 205 days in SIS and SBS, respectively.
CONCLUSIONS
Other than a trend to higher adverse event rates including post-procedure pancreatitis in SBS, clinical outcomes of SIS and SBS methods were comparable in patients with unresectable hilar MBO.
Identifiants
pubmed: 32107675
doi: 10.1007/s10620-020-06155-z
pii: 10.1007/s10620-020-06155-z
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3710-3718Commentaires et corrections
Type : CommentIn
Références
Perdue DG, Freeman ML, DiSario JA, et al. Plastic versus self-expanding metallic stents for malignant hilar biliary obstruction: a prospective multicenter observational cohort study. J Clin Gastroenterol. 2008;42:1040–1046.
doi: 10.1097/MCG.0b013e31815853e0
Sangchan A, Kongkasame W, Pugkhem A, et al. Efficacy of metal and plastic stents in unresectable complex hilar cholangiocarcinoma: a randomized controlled trial. Gastrointest Endosc. 2012;76:93–99.
doi: 10.1016/j.gie.2012.02.048
Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T, et al. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol. 2013;28:593–607.
doi: 10.1111/jgh.12128
Mukai T, Yasuda I, Nakashima M, et al. Metallic stents are more efficacious than plastic stents in unresectable malignant hilar biliary strictures: a randomized controlled trial. J Hepato-Biliary-Pancreat Sci. 2013;20:214–222.
doi: 10.1007/s00534-012-0508-8
Gao DJ, Hu B, Ye X, et al. Metal versus plastic stents for unresectable gallbladder cancer with hilar duct obstruction. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. 2017;29:97–103.
Dumonceau JM, Tringali A, Papanikolaou IS, et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline—updated october 2017. Endoscopy. 2018;50:910–930.
doi: 10.1055/a-0659-9864
Vienne A, Hobeika E, Gouya H, et al. Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment. Gastrointest Endosc. 2010;72:728–735.
doi: 10.1016/j.gie.2010.06.040
Takahashi E, Fukasawa M, Sato T, et al. Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry. World J Gastroenterol. 2015;21:4946–4953.
doi: 10.3748/wjg.v21.i16.4946
Chang WH, Kortan P, Haber GB. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. Gastrointest Endosc. 1998;47:354–362.
doi: 10.1016/S0016-5107(98)70218-4
De Palma GD, Galloro G, Siciliano S, et al. Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study. Gastrointest Endosc. 2001;53:547–553.
doi: 10.1067/mge.2001.113381
Naitoh I, Ohara H, Nakazawa T, et al. Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction. J Gastroenterol Hepatol. 2009;24:552–557.
doi: 10.1111/j.1440-1746.2008.05750.x
Iwano H, Ryozawa S, Ishigaki N, et al. Unilateral versus bilateral drainage using self-expandable metallic stent for unresectable hilar biliary obstruction. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. 2011;23:43–48.
Liberato MJ, Canena JM. Endoscopic stenting for hilar cholangiocarcinoma: efficacy of unilateral and bilateral placement of plastic and metal stents in a retrospective review of 480 patients. BMC Gastroenterol. 2012;12:103.
doi: 10.1186/1471-230X-12-103
Lee TH, Kim TH, Moon JH, et al. Bilateral versus unilateral placement of metal stents for inoperable high-grade malignant hilar biliary strictures: a multicenter, prospective, randomized study (with video). Gastrointest Endosc. 2017;86:817–827.
doi: 10.1016/j.gie.2017.04.037
Kogure H, Isayama H, Nakai Y, et al. Newly designed large cell Niti-S stent for malignant hilar biliary obstruction: a pilot study. Surg Endosc. 2011;25:463–467.
doi: 10.1007/s00464-010-1194-8
Kogure H, Isayama H, Nakai Y, et al. High single-session success rate of endoscopic bilateral stent-in-stent placement with modified large cell Niti-S stents for malignant hilar biliary obstruction. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. 2014;26:93–99.
Lee JM, Lee SH, Chung KH, et al. Small cell-versus large cell-sized metal stent in endoscopic bilateral stent-in-stent placement for malignant hilar biliary obstruction. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. 2015;27:692–699.
Saleem A, Baron TH, Gostout CJ. Large-diameter therapeutic channel duodenoscope to facilitate simultaneous deployment of side-by-side self-expandable metal stents in hilar cholangiocarcinoma. Gastrointest Endosc. 2010;72:628–631.
doi: 10.1016/j.gie.2010.04.035
Naitoh I, Hayashi K, Nakazawa T, et al. Side-by-side versus stent-in-stent deployment in bilateral endoscopic metal stenting for malignant hilar biliary obstruction. Dig Dis Sci. 2012;57:3279–3285. https://doi.org/10.1007/s10620-012-2270-9 .
doi: 10.1007/s10620-012-2270-9
pubmed: 22732832
Law R, Baron TH. Bilateral metal stents for hilar biliary obstruction using a 6Fr delivery system: outcomes following bilateral and side-by-side stent deployment. Dig Dis Sci. 2013;58:2667–2672. https://doi.org/10.1007/s10620-013-2671-4 .
doi: 10.1007/s10620-013-2671-4
pubmed: 23625287
Yoshida T, Hara K, Imaoka H, et al. Benefits of side-by-side deployment of 6-mm covered self-expandable metal stents for hilar malignant biliary obstructions. J Hepato-Biliary-Pancreat Sci. 2016;23:548–555.
doi: 10.1002/jhbp.372
Kawakubo K, Kawakami H, Kuwatani M, et al. Single-step simultaneous side-by-side placement of a self-expandable metallic stent with a 6-Fr delivery system for unresectable malignant hilar biliary obstruction: a feasibility study. J Hepato-Biliary-Pancreat Sci. 2015;22:151–155.
doi: 10.1002/jhbp.173
Cosgrove N, Siddiqui AA, Adler DG, et al. A comparison of bilateral side-by-side metal stents deployed above and across the sphincter of oddi in the management of malignant hilar biliary obstruction. J Clin Gastroenterol. 2016;51:528–533.
doi: 10.1097/MCG.0000000000000584
Hsieh J, Thosani A, Grunwald M, et al. Serial insertion of bilateral uncovered metal stents for malignant hilar obstruction using an 8 Fr biliary system: a case series of 17 consecutive patients. Hepatobiliary Surg Nutr. 2015;4:348–353.
pubmed: 26605283
pmcid: 4607839
Moon JH, Rerknimitr R, Kogure H, et al. Topic controversies in the endoscopic management of malignant hilar strictures using metal stent: side-by-side versus stent-in-stent techniques. J Hepato-Biliary-Pancreat Sci. 2015;22:650–656.
doi: 10.1002/jhbp.270
Lee TH, Moon JH, Choi JH, et al. Prospective comparison of endoscopic bilateral stent-in-stent versus stent-by-stent deployment for inoperable advanced malignant hilar biliary stricture. Gastrointest Endosc. 2019;90:222–230.
doi: 10.1016/j.gie.2019.03.011
Ito K, Sakamoto Y, Isayama H, et al. The impact of MDCT and endoscopic transpapillary mapping biopsy to predict longitudinal spread of extrahepatic cholangiocarcinoma. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2018;22:1528–1537.
doi: 10.1007/s11605-018-3793-y
Isayama H, Hamada T, Yasuda I, et al. TOKYO criteria 2014 for transpapillary biliary stenting. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. 2015;27:259–264.
Nakai Y, Isayama H, Tsujino T, et al. Intraductal US in the assessment of tumor involvement to the orifice of the cystic duct by malignant biliary obstruction. Gastrointest Endosc. 2008;68:78–83.
doi: 10.1016/j.gie.2007.12.063
Kongkam P, Tasneem AA, Rerknimitr R. Combination of endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography-guided biliary drainage in malignant hilar biliary obstruction. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. 2019;31:50–54.
Nakai Y, Kogure H, Isayama H, et al. Endoscopic ultrasound-guided biliary drainage for unresectable hilar malignant biliary obstruction. Clin Endosc. 2019;52:220–225.
doi: 10.5946/ce.2018.094
Tarnasky PR, Cunningham JT, Hawes RH, et al. Transpapillary stenting of proximal biliary strictures: does biliary sphincterotomy reduce the risk of postprocedure pancreatitis? Gastrointest Endosc. 1997;45:46–51.
doi: 10.1016/S0016-5107(97)70301-8
Kawakubo K, Isayama H, Nakai Y, et al. Risk factors for pancreatitis following transpapillary self-expandable metal stent placement. Surg Endosc. 2012;26:771–776.
doi: 10.1007/s00464-011-1950-4
Shiomi H, Matsumoto K, Isayama H. Management of acute cholangitis as a result of occlusion from a self-expandable metallic stent in patients with malignant distal and hilar biliary obstructions. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. 2017;29:88–93.
Inoue T, Naitoh I, Okumura F, et al. Reintervention for stent occlusion after bilateral self-expandable metallic stent placement for malignant hilar biliary obstruction. Dig Endosc Off J Jpn Gastroenterol Endosc Soc. 2016;28:731–737.
Okuno M, Mukai T, Iwashita T, et al. Evaluation of endoscopic reintervention for self-expandable metallic stent obstruction after stent-in-stent placement for malignant hilar biliary obstruction. J Hepato-Biliary-Pancreat Sci. 2019;26:211–218.
doi: 10.1002/jhbp.626