Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Percutaneous Biliary Drainage Using Open Cell Stents for Malignant Biliary Hilar Obstruction

  • Ahn, Sun Jun (Department of Radiology, Ajou University School of Medicine) ;
  • Bae, Jae Ik (Department of Radiology, Ajou University School of Medicine) ;
  • Han, Tae Sun (Department of Radiology, Ajou University School of Medicine) ;
  • Won, Je Hwan (Department of Radiology, Ajou University School of Medicine) ;
  • Kim, Ji Dae (Department of Radiology, Ajou University School of Medicine) ;
  • Kwack, Kyu-Sung (Department of Radiology, Ajou University School of Medicine) ;
  • Lee, Jae Hee (Department of Radiology, Ajou University School of Medicine) ;
  • Kim, Young Chul (Department of Radiology, Ajou University School of Medicine)
  • Published : 2012.12.01
⟨ Previous Next ⟩

Abstract

Objective: To evaluate the feasibility, safety and the effectiveness of the complex assembly of open cell nitinol stents for biliary hilar malignancy. Materials and Methods: During the 10 month period between January and October 2007, 26 consecutive patients with malignant biliary hilar obstruction underwent percutaneous insertion of open cell design nitinol stents. Four types of stent placement methods were used according to the patients' ductal anatomy of the hilum. We evaluated the technical feasibility of stent placement, complications, patient survival, and the duration of stent patency. Results: Bilobar biliary stent placement was conducted in 26 patients with malignant biliary obstruction-T (n = 9), Y (n = 7), crisscross (n = 6) and multiple intersecting types (n = 4). Primary technical success was obtained in 24 of 26 (93%) patients. The crushing of the 1st stent during insertion of the 2nd stent occurred in two cases. Major complications occurred in 2 of 26 patients (7.7%). One case of active bleeding from hepatic segmental artery and one case of sepsis after procedure occurred. Clinical success was achieved in 21 of 24 (87.5%) patients, who were followed for a mean of 141.5 days (range 25-354 days). The mean primary stent patency period was 191.8 days and the mean patient survival period was 299 days. Conclusion: Applying an open cell stent in the biliary system is feasible, and can be effective, especially in multiple intersecting stent insertions in the hepatic hilum.

Keywords

References

  1. Nordback IH, Pitt HA, Coleman J, Venbrux AC, Dooley WC, Yeu NN, et al. Unresectable hilar cholangiocarcinoma: percutaneous versus operative palliation. Surgery 1994;115:597-603
  2. LaBerge JM, Doherty M, Gordon RL, Ring EJ. Hilar malignancy: treatment with an expandable metallic transhepatic biliary stent. Radiology 1990;177:793-797 https://doi.org/10.1148/radiology.177.3.2173842
  3. Kim CW, Park AW, Won JW, Kim S, Lee JW, Lee SH. T-configured dual stent placement in malignant biliary hilar duct obstructions with a newly designed stent. J Vasc Interv Radiol 2004;15:713-717 https://doi.org/10.1097/01.RVI.0000133508.79090.A2
  4. Inal M, Akgul E, Aksungur E, Seydaoglu G. Percutaneous placement of biliary metallic stents in patients with malignant hilar obstruction: unilobar versus bilobar drainage. J Vasc Interv Radiol 2003;14:1409-1416 https://doi.org/10.1097/01.RVI.0000096762.74047.A6
  5. De Palma GD, Galloro G, Siciliano S, Iovino P, Catanzano C. Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study. Gastrointest Endosc 2001;53:547-553 https://doi.org/10.1067/mge.2001.113381
  6. Cowling MG, Adam AN. Internal stenting in malignant biliary obstruction. World J Surg 2001;25:355-359; discussion 359-361 https://doi.org/10.1007/s002680020384
  7. Rerknimitr R, Kladcharoen N, Mahachai V, Kullavanijaya P. Result of endoscopic biliary drainage in hilar cholangiocarcinoma. J Clin Gastroenterol 2004;38:518-523 https://doi.org/10.1097/01.mcg.0000123204.36471.be
  8. Choi KH, Cho YK, An JK, Woo JJ, Kim HS, Choi YS. Acute obstructive cholangitis after transarterial chemoembolization: the effect of percutaneous transhepatic removal of tumor fragment. Korean J Radiol 2009;10:197-201 https://doi.org/10.3348/kjr.2009.10.2.197
  9. Han YM, Kwak HS, Jin GY, Lee SO, Chung GH. Treatment of malignant biliary obstruction with a PTFE-covered self-expandable nitinol stent. Korean J Radiol 2007;8:410-417 https://doi.org/10.3348/kjr.2007.8.5.410
  10. Kim JH. Clinical feasibility and usefulness of CT fluoroscopy-guided percutaneous transhepatic biliary drainage in emergency patients with acute obstructive cholangitis. Korean J Radiol 2009;10:144-149 https://doi.org/10.3348/kjr.2009.10.2.144
  11. Lee JH, Kang DH, Kim JY, Lee SM, Kim do H, Park CW, et al. Endoscopic bilateral metal stent placement for advanced hilar cholangiocarcinoma: a pilot study of a newly designed Y stent. Gastrointest Endosc 2007;66:364-369 https://doi.org/10.1016/j.gie.2006.12.061
  12. Topazian M. Toward a better biliary confluence stent. Gastrointest Endosc 2007;66:369-371 https://doi.org/10.1016/j.gie.2007.02.047
  13. Duda SH, Wiskirchen J, Tepe G, Bitzer M, Kaulich TW, Stoeckel D, et al. Physical properties of endovascular stents: an experimental comparison. J Vasc Interv Radiol 2000;11:645-654 https://doi.org/10.1016/S1051-0443(07)61620-0
  14. Sobolevsky SA, Rakin D, Janne d'Othee B, Lang EV. Complex stent assemblies: feasibility of stent-through-stent deployment. Cardiovasular and Interventional Society of Europe e-poster: P100 September 2006
  15. Rutledge JM, Grifka RG, Bryant LL, Mullins CE, Vincent JA. Balloon dilation and stent implant through the side of a previously placed intravascular stent: a new option for the interventionalist. Catheter Cardiovasc Interv 2002;56:387-393 https://doi.org/10.1002/ccd.10197
  16. Pierce DS, Rosero EB, Modrall JG, Adams-Huet B, Valentine RJ, Clagett GP, et al. Open-cell versus closed-cell stent design differences in blood flow velocities after carotid stenting. J Vasc Surg 2009;49:602-606; discussion 606 https://doi.org/10.1016/j.jvs.2008.10.016
  17. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003;14(9 Pt 2):S199-S202 https://doi.org/10.1097/01.RVI.0000094584.83406.3e
  18. Bae JI, Park AW, Choi SJ, Kim HP, Lee SJ, Park YM, et al. Crisscross-configured dual stent placement for trisectoral drainage in patients with advanced biliary hilar malignancies. J Vasc Interv Radiol 2008;19:1614-1619 https://doi.org/10.1016/j.jvir.2008.08.006
  19. Dumas R, Demuth N, Buckley M, Peten EP, Manos T, Demarquay JF, et al. Endoscopic bilateral metal stent placement for malignant hilar stenoses: identification of optimal technique. Gastrointest Endosc 2000;51:334-338 https://doi.org/10.1016/S0016-5107(00)70364-6
  20. Kim JY, Kang DH, Kim HW, Choi CW, Kim ID, Hwang JH, et al. Usefulness of slimmer and open-cell-design stents for endoscopic bilateral stenting and endoscopic revision in patients with hilar cholangiocarcinoma (with video). Gastrointest Endosc 2009;70:1109-1115 https://doi.org/10.1016/j.gie.2009.05.013
  21. Muller-Hulsbeck S, Schafer PJ, Charalambous N, Schaffner SR, Heller M, Jahnke T. Comparison of carotid stents: an invitro experiment focusing on stent design. J Endovasc Ther 2009;16:168-177 https://doi.org/10.1583/08-2539.1
  22. Park do H, Lee SS, Moon JH, Choi HJ, Cha SW, Kim JH, et al. Newly designed stent for endoscopic bilateral stent-in-stent placement of metallic stents in patients with malignant hilar biliary strictures: multicenter prospective feasibility study (with videos). Gastrointest Endosc 2009;69:1357-1360 https://doi.org/10.1016/j.gie.2008.12.250

Cited by

  1. RE: Percutaneous Retroperitoneal Access vol.15, pp.1, 2014, https://doi.org/10.3348/kjr.2014.15.1.179
  2. Palliation: Hilar cholangiocarcinoma vol.6, pp.8, 2014, https://doi.org/10.4254/wjh.v6.i8.559
  3. Malignant Hilar Biliary Obstruction: Treatment by Means of Placement of a Newly Designed Y-Shaped Branched Covered Stent vol.39, pp.4, 2016, https://doi.org/10.1007/s00270-015-1205-1
  4. Interventional radiologic approach to hilar malignant biliary obstruction vol.5, pp.1, 2016, https://doi.org/10.18528/gii150004
  5. Multiple metallic stents placement for malignant hilar biliary obstruction: Perspective of a radiologist vol.5, pp.1, 2012, https://doi.org/10.18528/gii150027
  6. Percutaneous Transhepatic Biliary Stenting with Uncovered Self-Expandable Metallic Stents in Patients with Malignant Biliary Obstruction – Efficacy and Survival Analysis vol.82, pp.None, 2012, https://doi.org/10.12659/pjr.901785
  7. Percutaneous stent-in-stent placement with large cell-type stents for malignant hilar biliary obstruction vol.62, pp.12, 2012, https://doi.org/10.1177/0284185120978512