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Which is better for unresectable malignant hilar biliary obstruction: Side-by-side versus stent-in-stent?

Itaru Naitoh|Tadahisa Inoue|Kazuki Hayashi
소화기인터벤션의학회 (The Society of Gastrointestinal Intervention)|2018.07|International Journal of Gastrointestinal Intervention|제7권 제2호|pp. 78-84

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키워드

CholestasisCholangiopancreatographyendoscopic retrogradeSelf expandable metallic stentsKlatskin tumor

초록

Biliary drainage is required for the management of unresectable malignant hilar biliary obstruction (UMHBO), and endoscopic transpapillary drainage is the first-line therapy because it is less invasive. Self-expandable metallic stents (SEMSs) are superior to plastic stents because they have longer stent patency and are more cost-effective. Endoscopic bilateral SEMS placement is technically challenging compared to unilateral placement. However, recent developments in devices and techniques have facilitated bilateral SEMS placement. There are two methods for bilateral hilar SEMS placement for UMHBO: side-by-side (SBS) and stent-in-stent (SIS). Sequential SBS was commonly conducted for bilateral hilar SEMS placement. In a new and thinner delivery system that was developed for SEM placement, two SEMSs could be simultaneously inserted and deployed through the working channel. This new bilateral stenting method enabled us to accomplish simultaneous SBS placement, which increased the success rate of SBS. Insertion of the guidewire and delivery of the second SEMS through the mesh of the first SEMS is challenging in SIS. Newly designed or modified SEMSs that are suitable for SIS have been developed to overcome this challenge, and these SEMSs have facilitated SIS. Uncovered SEMS has been commonly used for hilar SEMS placement, but covered SEMS (CSEMS) is another option for hilar SEMS placement, because CSEMS prevents tumor ingrowth and allows for removal of the stent for re-intervention. Therefore, CSEMS can be used for bilateral SEMS placement in SBS. There are many methods and kinds of SEMS available for bilateral SEMS placement. However, due to lack of evidence, there is no consensus on whether SBS or SIS is optimal for bilateral hilar SEMS placement. In this review, we compared various outcomes between SBS and SIS from previous studies, to clarify which method is better for bilateral SEMS placement for UMHBO.

Abstract

Biliary drainage is required for the management of unresectable malignant hilar biliary obstruction (UMHBO), and endoscopic transpapillary drainage is the first-line therapy because it is less invasive. Self-expandable metallic stents (SEMSs) are superior to plastic stents because they have longer stent patency and are more cost-effective. Endoscopic bilateral SEMS placement is technically challenging compared to unilateral placement. However, recent developments in devices and techniques have facilitated bilateral SEMS placement. There are two methods for bilateral hilar SEMS placement for UMHBO: side-by-side (SBS) and stent-in-stent (SIS). Sequential SBS was commonly conducted for bilateral hilar SEMS placement. In a new and thinner delivery system that was developed for SEM placement, two SEMSs could be simultaneously inserted and deployed through the working channel. This new bilateral stenting method enabled us to accomplish simultaneous SBS placement, which increased the success rate of SBS. Insertion of the guidewire and delivery of the second SEMS through the mesh of the first SEMS is challenging in SIS. Newly designed or modified SEMSs that are suitable for SIS have been developed to overcome this challenge, and these SEMSs have facilitated SIS. Uncovered SEMS has been commonly used for hilar SEMS placement, but covered SEMS (CSEMS) is another option for hilar SEMS placement, because CSEMS prevents tumor ingrowth and allows for removal of the stent for re-intervention. Therefore, CSEMS can be used for bilateral SEMS placement in SBS. There are many methods and kinds of SEMS available for bilateral SEMS placement. However, due to lack of evidence, there is no consensus on whether SBS or SIS is optimal for bilateral hilar SEMS placement. In this review, we compared various outcomes between SBS and SIS from previous studies, to clarify which method is better for bilateral SEMS placement for UMHBO.

참고문헌 (42)

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관련 논문AI추천

Optimal endoscopic drainage strategy for unresectable malignant hilar biliary obstructionItaru Naitoh, Tadahisa Inoue대한소화기내시경학회 · Clinical Endoscopy2023 · 제56권 제2호Bilateral Metallic Stenting in Malignant Hilar Obstruction문종호, 박상흠, 이태훈대한소화기내시경학회 · Clinical Endoscopy2014 · 제47권 제5호Prospective Multicenter Study of the Challenges Inherent in Using Large Cell-Type Stents for Bilateral Stent-in-Stent Placement in Patients with Inoperable Malignant Hilar Biliary ObstructionByung Moo Yoo, Don Haeng Lee, Jae Chul Hwang, Ji Kon Ryu, Jin Hong Kim, Min Jae Yang, Sang Hyub Lee, Sang Myung Woo, Seok Jeong, Woo Jin Lee, Yong-Tae Kim거트앤리버 소화기연관학회협의회 · Gut and Liver2018 · 제12권 제6호The Comparison of Endoscopic Biliary Drainage in Malignant Hilar Obstruction by Cholangiocarcinoma: Bilateral Metal Stents versus Multiple Plastic Stents이광혁, Kang Danbee, Kim Jun Young, Lee Dong Kyu, Lee Jong Kyun, Lee Kyu Taek, Lee Sang-geul, Park Joo Kyung거트앤리버 소화기연관학회협의회 · Gut and Liver2021 · 제15권 제6호Comparison of Bilateral and Trisegment Drainage in Patients with High-Grade Hilar Malignant Biliary Obstruction: A Multicenter Retrospective StudyKato Hironari, Kawamoto Hirofumi, Matsumoto Kazuyuki, Miyamoto Kazuya, Morimoto Kosaku, Okada Hiroyuki, Saragai Yosuke거트앤리버 소화기연관학회협의회 · Gut and Liver2023 · 제17권 제1호Endoscopic drainage in patients with inoperable hilar cholangiocarcinoma강대환, 박여진대한내과학회 · The Korean Journal of Internal Medicine2013 · 제28권 제1호

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