Expandable metal stents for endoscopic bilateral stent-within-stent placement for malignant hilar biliary obstruction.

BACKGROUND

Placement of biliary stents is effective for palliation of unresectable hilar malignant biliary obstruction. However, when bilateral self-expandable metal stents (SEMSs) are used, placement can be technically challenging. In many studies, side-by-side placement is performed, although it is unclear whether this is the most anatomical and functional approach.

OBJECTIVE

We sought to assess the technical feasibility and effectiveness of deploying bilateral SEMSs with a stent-within-stent approach using commercially available stents with a large cell width.

DESIGN

Retrospective study.

SETTING

Tertiary care medical center.

PATIENTS

Patients with malignant biliary hilar obstruction referred for endoscopic palliation of obstructive jaundice.

MAIN OUTCOME MEASUREMENTS

Technical success, ie, successful bilateral SEMS placement across the stricture; functional success, ie, decrease in pretreatment bilirubin level; early and late complications; and stent patency.

RESULTS

Bilateral biliary drainage was attempted and successfully established in 21 patients with malignant hilar obstruction (15 men, 6 women; mean age 63.7 [standard deviation 13.9] years), resulting in clinical improvement of obstructive symptoms. Median follow-up was 6.14 months (interquartile range 3.5-9.5 months). There were 1 (5%) early and 7 (33%) late stent occlusions that required endoscopic reintervention. The 30-day mortality rate was 10% (2 deaths).

LIMITATIONS

Retrospective study of a series of cases treated at a tertiary care center by expert endoscopists.

CONCLUSIONS

This simple technique was performed by using an open-cell expandable metal stent is technically feasible and easy and allows bilateral placement of SEMSs in patients with unresectable hilar malignancy.