Kobayashi Makoto
Division of Gastroenterology, Yokkaichi Municipal Hospital, Yokkaichi, Mie 5108657, Japan.
World J Clin Cases. 2019 Jun 6;7(11):1323-1328. doi: 10.12998/wjcc.v7.i11.1323.
Uncovered stents used for malignant obstructions in the biliary tree, especially in the hilar area, are prone to obstruction by tumor ingrowths. In comparison, however, covered stents may block bile duct branches and are at risk of migration. We have developed a multi-hole self-expandable metallic stent (MHSEMS), with a hole in each cell, to prevent the obstruction of bile duct branches. In addition, the holes may prevent migration due to small ingrowths by reducing the tension of the membrane.
MHSEMS were placed in five patients with a malignant obstruction and one with post-endoscopic sphincterotomy bleeding. Each MHSEMS was successfully deployed in all cases. Patients showed no complications. Two cases were reviewed. Case 1: A 74-year-old male presented with jaundice and was diagnosed with a sigmoid colon cancer and giant liver metastases in the right liver lobe. A MHSEMS was placed in the left bile duct. The jaundice improved and peroral cholangioscopy was performed. Case 2: A 90-year-old female was admitted to hospital for jaundice and diagnosed with cholangiocarcinoma. A MHSEMS was placed in the left bile duct but after 8 months the stent became obstructed by tumor ingrowth. We treated the patient by ablation therapy. A silicone cover separated the internal bile duct from the surrounding tissue, protecting the latter from thermal injury during treatment by endobiliary ablation of the re-obstruction.
A MHSEMS is a new choice of stent for biliary tract diseases.
用于胆道恶性梗阻的裸支架，尤其是肝门区的支架，容易被肿瘤长入阻塞。然而，相比之下，覆膜支架可能会阻塞胆管分支，并有移位风险。我们研发了一种多孔自膨式金属支架（MHSEMS），每个单元都有一个孔，以防止胆管分支阻塞。此外，这些孔可通过降低膜的张力来防止因小的肿瘤长入而导致的移位。
在5例恶性梗阻患者和1例内镜下括约肌切开术后出血患者中置入了MHSEMS。所有病例中每个MHSEMS均成功置入。患者未出现并发症。对2例病例进行了回顾。病例1：一名74岁男性出现黄疸，被诊断为乙状结肠癌并伴有右肝叶巨大肝转移。在左胆管置入了一个MHSEMS。黄疸得到改善，并进行了经口胆管镜检查。病例2：一名90岁女性因黄疸入院，被诊断为胆管癌。在左胆管置入了一个MHSEMS，但8个月后支架被肿瘤长入阻塞。我们对该患者进行了消融治疗。一个硅胶覆盖物将肝内胆管与周围组织隔开，在对再阻塞进行胆管内消融治疗期间保护周围组织免受热损伤。
MHSEMS是胆道疾病支架的一种新选择。
