TSOZ Pancreatobiliary Study Group, Osaka, Japan.
2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
J Hepatobiliary Pancreat Sci. 2020 Feb;27(2):84-89. doi: 10.1002/jhbp.688. Epub 2019 Nov 13.
Malignant hilar biliary obstruction (MHBO) can be treated with bilateral self-expandable metal stents (SEMS) deployed using side-by-side (SBS) or stent-in-stent (SIS) techniques. Moving cell stents (MCS) are a novel type of SEMS. The present study evaluated the technical feasibility of treating MHBO using bilateral novel uncovered SEMS to insert an SIS technique without dilating the mesh of a first stent within a single session.
We retrospectively assessed patients who were complicated with obstructive jaundice due to MHBO between August and December 2018. Technical success was defined as the deployment of a bilateral MCS into two or more biliary tracts using SIS technique without a dilation device.
The present study analyzed data from 23 consecutive patients who were complicated with MHBO. Bilateral SIS technique with MCS was deployed in 22 (95.6%) of the 23 patients without dilating the mesh of the first stent. Multiple guidewire insertion failed in one patient with Bismuth-type IV. The median procedural duration was 33.6 min. Time to recurrent biliary obstruction was 230 days. Severe adverse events were not seen in any patients.
In conclusion, uncovered moving cell SEMS might facilitate bilateral stent deployment using SIS technique.
恶性肝门胆管阻塞（MHBO）可以通过双侧自膨式金属支架（SEMS）进行治疗，这些支架可以采用并排（SBS）或支架内支架（SIS）技术进行部署。移动细胞支架（MCS）是一种新型的 SEMS。本研究评估了使用双侧新型 uncovered SEMS 治疗 MHBO 的技术可行性，以便在单次治疗中不使用扩张器扩张第一个支架的网孔来插入 SIS 技术。
我们回顾性评估了 2018 年 8 月至 12 月期间因 MHBO 而并发梗阻性黄疸的患者。技术成功定义为使用 SIS 技术在两个或更多胆道中部署双侧 MCS，而无需使用扩张器。
本研究分析了 23 例并发 MHBO 的连续患者的数据。23 例患者中的 22 例（95.6%）采用 MCS 成功实施了双侧 SIS 技术，而无需扩张第一个支架的网孔。在 1 例 Bismuth 型 IV 患者中，多次导丝插入失败。中位手术时间为 33.6 分钟。复发性胆道阻塞的时间为 230 天。未观察到严重不良事件。
总之，uncovered moving cell SEMS 可能有助于使用 SIS 技术进行双侧支架部署。
