Yonsei Med J.  2018 Sep;59(7):827-833. 10.3349/ymj.2018.59.7.827.

Clinical Outcomes of Bilateral Stent-in-Stent Placement Using Self-Expandable Metallic Stent for High-Grade Malignant Hilar Biliary Obstruction

Affiliations
  • 1Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. bang7028@yuhs.ac
  • 2Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
  • 3Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. gidoctor@snuh.org

Abstract

PURPOSE
Endoscopic bile duct decompression using bilateral self-expandable metallic stents (SEMSs) deployed via a stent-in-stent (SIS) method is considered a preferred procedure for malignant hilar biliary obstruction (MHBO). However, occlusion thereof occurs frequently. Here, we investigated stent patency duration and risk factors related to stent obstruction with bilateral SIS placement for MHBO at two large centers.
MATERIALS AND METHODS
The present study reviewed data on patients with MHBO who underwent endoscopic biliary drainage using the SIS method. Clinical outcomes, including stent patency duration and patient overall survival, were analyzed. Factors associated with stent patency were evaluated using Cox proportional hazards models.
RESULTS
Seventy patients with MHBO underwent endoscopic biliary drainage using the SIS method. Median age was 68 years old, and median follow-up duration was 140 days (interquartile range, 57-329). The proportion of high-grade MHBOs (Bismuth type IV) was 57.1%. Median stent patency duration with the SIS method was 108 days according to Kaplan-Meier curves. Median patient survival analyzed by the Kaplan-Meier method was 181 days. Multivariate analysis indicated that higher baseline bilirubin (> 6.1 mg/dL) as an independent risk factor related to stent patency (p < 0.05).
CONCLUSION
In endoscopic biliary decompression using SEMS placed with the SIS method, obstructive jaundice was a risk factor for stent patency. The SIS method for high-grade MHBO showed short stent patency.

Keyword

Malignant hilar biliary obstruction; stent-in-stent; self-expandable metallic stent; stent patency

MeSH Terms

Bile Ducts
Bilirubin
Decompression
Drainage
Follow-Up Studies
Humans
Jaundice, Obstructive
Methods
Multivariate Analysis
Proportional Hazards Models
Risk Factors
Stents*
Bilirubin

Figure

  • Fig. 1 Representative images. (A) Malignant hilar biliary obstruction. (B) Bilateral stent-in-stent placement.

  • Fig. 2 Cumulative stent patency of bilateral hilar metal stent as analyzed by Kaplan-Meier curves. Median survival time analyzed by the Kaplan-Meier method was 108 days.

  • Fig. 3 Kaplan-Meier curve of patient overall survival after placement of bilateral metal stent. Median survival time analyzed by Kaplan-Meier method was 181 days.


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