The Korean journal of internal medicine

  • 제28권1호
  • /
  • Pages.8-18
  • /
  • 2013
  • /
  • 1226-3303(pISSN)
  • /
  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

Endoscopic drainage in patients with inoperable hilar cholangiocarcinoma

  • Park, Ye Jin (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kang, Dae Hwan (Department of Internal Medicine, Pusan National University School of Medicine)
  • 발행 : 2013.01.01
⟨ 이전 논문 다음 논문 ⟩

초록

Hilar cholangiocarcinoma has an extremely poor prognosis and is usually diagnosed at an advanced stage. Palliative management plays an important role in the treatment of patients with inoperable hilar cholangiocarcinoma. Surgical, percutaneous, and endoscopic biliary drainage are three modalities available to resolve obstructive jaundice. Plastic stents were widely used in the past; however, self-expanding metal stents (SEMS) have become popular recently due to their long patency and reduced risk of side branch obstruction, and SEMS are now the accepted treatment of choice for hilar cholangiocarcinoma. Bilateral drainage provides more normal and physiological biliary flow through the biliary ductal system than that of unilateral drainage. Unilateral drainage was preferred until recently because of its technical simplicity. But, with advancements in technology, bilateral drainage now achieves a high success rate and is the preferred treatment modality in many centers. However, the choice of unilateral or bilateral drainage is still controversial, and more studies are needed. This review focuses on the endoscopic method and discusses stent materials and types of procedures for patients with a hilar cholangiocarcinoma.

키워드

참고문헌

  1. Altemeier WA, Gall EA, Zinninger MM, Hoxworth PI. Sclerosing carcinoma of the major intrahepatic bile ducts. AMA Arch Surg 1957;75:450-460. https://doi.org/10.1001/archsurg.1957.01280150140015
  2. Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis: an unusual tumor with distinctive clinical and pathological features. Am J Med 1965;38:241-256. https://doi.org/10.1016/0002-9343(65)90178-6
  3. Classen M, Hagenmuller F. Endoscopic biliary drainage. Scand J Gastroenterol Suppl 1984;102:76-83.
  4. Siegel JH. Improved biliary decompression with large caliber endoscopic prostheses. Gastrointest Endosc 1984;30:21-23. https://doi.org/10.1016/S0016-5107(84)72288-7
  5. Moss AC, Morris E, Leyden J, MacMathuna P. Do the benefits of metal stents justify the costs? A systematic review and meta-analysis of trials comparing endoscopic stents for malignant biliary obstruction. Eur J Gastroenterol Hepatol 2007;19:1119-1124. https://doi.org/10.1097/MEG.0b013e3282f16206
  6. Siegel JH, Pullano W, Wright G, Halpern G. The ultimate large caliber endoprosthesis-$_{12}F$: poiseuille was right: bigger is better. Gastrointest Endosc 1985;31:158.
  7. Singhal D, van Gulik TM, Gouma DJ. Palliative management of hilar cholangiocarcinoma. Surg Oncol 2005;14:59-74. https://doi.org/10.1016/j.suronc.2005.05.004
  8. Freeman ML, Sielaff TD. A modern approach to malignant hilar biliary obstruction. Rev Gastroenterol Disord 2003;3:187-201.
  9. Anderson CD, Pinson CW, Berlin J, Chari RS. Diagnosis and treatment of cholangiocarcinoma. Oncologist 2004;9:43-57.
  10. Liu CL, Lo CM, Lai EC, Fan ST. Endoscopic retrograde cholangiopancreatography and endoscopic endoprosthesis insertion in patients with Klatskin tumors. Arch Surg 1998;133:293-296. https://doi.org/10.1001/archsurg.133.3.293
  11. Iwano H, Ryozawa S, Harano M, et al. Management of unresectable hilar biliary obstruction: plastic stents versus metallic stents and unilateral versus bilateral biliary drainage. Bull Yamaguchi Med Sch 2008;55:9-14.
  12. Kim YT. Endoscopic stent drainage for malignant biliary obstruction: the Korean experience. Dig Endosc 2006;18:154-156. https://doi.org/10.1111/j.1443-1661.2006.00585.x
  13. Wagner HJ, Knyrim K, Vakil N, Klose KJ. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction: a prospective and randomized trial. Endoscopy 1993;25:213-218. https://doi.org/10.1055/s-2007-1010295
  14. Libby ED, Leung JW. Prevention of biliary stent clogging: a clinical review. Am J Gastroenterol 1996;91:1301-1308.
  15. Galandi D, Schwarzer G, Bassler D, Allgaier HP. Ursodeoxycholic acid and/or antibiotics for prevention of biliary stent occlusion. Cochrane Database Syst Rev 2002;(3):CD003043.
  16. Jansen B, Goodman LP, Ruiten D. Bacterial adherence to hydrophilic polymer-coated polyurethane stents. Gastrointest Endosc 1993;39:670-673. https://doi.org/10.1016/S0016-5107(93)70220-5
  17. Rees EN, Tebbs SE, Elliott TS. Role of antimicrobialimpregnated polymer and Tef lon in the prevention of biliary stent blockage. J Hosp Infect 1998;39:323-329. https://doi.org/10.1016/S0195-6701(98)90298-5
  18. Sung JY, Shaffer EA, Lam K, Rususka I, Costerton JW. Hydrophobic bile salt inhibits bacterial adhesion on biliary stent material. Dig Dis Sci 1994;39:999-1006. https://doi.org/10.1007/BF02087551
  19. Speer AG, Cotton PB, MacRae KD. Endoscopic management of malignant biliary obstruction: stents of 10 French gauge are preferable to stents of 8 French gauge. Gastrointest Endosc 1988;34:412-417. https://doi.org/10.1016/S0016-5107(88)71407-8
  20. Siegel JH, Pullano W, Kodsi B, Cooperman A, Ramsey W. Optimal palliation of malignant bile duct obstruction: experience with endoscopic 12 French prostheses. Endoscopy 1988;20:137-141. https://doi.org/10.1055/s-2007-1018158
  21. Gerhards MF, den Hartog D, Rauws EA, et al. Palliative treatment in patients with unresectable hilar cholangiocarcinoma: results of endoscopic drainage in patients with type III and IV hilar cholangiocarcinoma. Eur J Surg 2001;167:274-280. https://doi.org/10.1080/110241501300091444
  22. Raju RP, Jaganmohan SR, Ross WA, et al. Optimum palliation of inoperable hilar cholangiocarcinoma: comparative assessment of the efficacy of plastic and selfexpanding metal stents. Dig Dis Sci 2011;56:1557-1564. https://doi.org/10.1007/s10620-010-1550-5
  23. Peters RA, Williams SG, Lombard M, Karani J, Westaby D. The management of high-grade hilar strictures by endoscopic insertion of self-expanding metal endoprostheses. Endoscopy 1997;29:10-16. https://doi.org/10.1055/s-2007-1004054
  24. Dumas R, Demuth N, Buckley M, 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
  25. Cheng JL, Bruno MJ, Bergman JJ, Rauws EA, Tytgat GN, Huibregtse K. Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: efficacy of self-expandable metallic Wallstents. Gastrointest Endosc 2002;56:33-39. https://doi.org/10.1067/mge.2002.125364
  26. De Palma GD, Pezzullo A, Rega M, et al. Unilateral placement of metallic stents for malignant hilar obstruction: a prospective study. Gastrointest Endosc 2003;58:50-53. https://doi.org/10.1067/mge.2003.310
  27. Kawamoto H, Tsutsumi K, Harada R, et al. Endoscopic deployment of multiple JOSTENT SelfX is effective and safe in treatment of malignant hilar biliary strictures. Clin Gastroenterol Hepatol 2008;6:401-408. https://doi.org/10.1016/j.cgh.2007.12.036
  28. Paik WH, Park YS, Hwang JH, et al. Palliative treatment with self-expandable metallic stents in patients with advanced type III or IV hilar cholangiocarcinoma: a percutaneous versus endoscopic approach. Gastrointest Endosc 2009;69:55-62. https://doi.org/10.1016/j.gie.2008.04.005
  29. Chennat J, Waxman I. Initial performance profile of a new 6F self-expanding metal stent for palliation of malignant hilar biliary obstruction. Gastrointest Endosc 2010;72:632-636. https://doi.org/10.1016/j.gie.2010.04.037
  30. Yoon WJ, Ryu JK, Yang KY, et al. A comparison of metal and plastic stents for the relief of jaundice in unresectable malignant biliary obstruction in Korea: an emphasis on cost-effectiveness in a country with a low ERCP cost. Gastrointest Endosc 2009;70:284-289. https://doi.org/10.1016/j.gie.2008.12.241
  31. Kaassis M, Boyer J, Dumas R, et al. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc 2003;57:178-182. https://doi.org/10.1067/mge.2003.66
  32. Abu-Hamda EM, Baron TH. Endoscopic management of cholangiocarcinoma. Semin Liver Dis 2004;24:165-175. https://doi.org/10.1055/s-2004-828893
  33. Chang WH, Kortan P, Haber GB. Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. Gastrointest Endosc 1998;47:354-362. https://doi.org/10.1016/S0016-5107(98)70218-4
  34. Li F, Wang F, Yang X, et al. Covered stents versus uncovered stents for the palliation of malignant extrahepatic biliary obstruction caused by direct tumor invasion: a cohort comparative study. Med Oncol 2012;29:2762-2770. https://doi.org/10.1007/s12032-012-0187-y
  35. Isayama H, Nakai Y, Kawakubo K, et al. Covered metallic stenting for malignant distal biliary obstruction: clinical results according to stent type. J Hepatobiliary Pancreat Sci 2011;18:673-677. https://doi.org/10.1007/s00534-011-0411-8
  36. Saleem A, Leggett CL, Murad MH, Baron TH. Metaanalysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction. Gastrointest Endosc 2011;74:321-327. https://doi.org/10.1016/j.gie.2011.03.1249
  37. Yoon WJ, Lee JK, Lee KH, et al. A comparison of covered and uncovered Wallstents for the management of distal malignant biliary obstruction. Gastrointest Endosc 2006;63:996-1000. https://doi.org/10.1016/j.gie.2005.11.054
  38. Dowsett JF, Vaira D, Hatf ield AR, et al. Endoscopic biliary therapy using the combined percutaneous and endoscopic technique. Gastroenterology 1989;96:1180-1186. https://doi.org/10.1016/0016-5085(89)91639-9
  39. Baer HU, Rhyner M, Stain SC, et al. The effect of communication between the right and left liver on the outcome of surgical drainage for jaundice due to malignant obstruction at the hilus of the liver. HPB Surg 1994;8:27-31. https://doi.org/10.1155/1994/17262
  40. Parodi A, Fisher D, Giovannini M, Baron T, Conio M. Endoscopic management of hilar cholangiocarcinoma. Nat Rev Gastroenterol Hepatol 2012;9:105-112. https://doi.org/10.1038/nrgastro.2011.271
  41. Brauer BC. Endoscopic palliation of malignant biliary obstruction. Tech Gastrointest Endosc 2009;11:26-34. https://doi.org/10.1016/j.tgie.2009.02.001
  42. Freeman ML, Overby C. Selective MRCP and CT-targeted drainage of malignant hilar biliary obstruction with self-expanding metallic stents. Gastrointest Endosc 2003;58:41-49. https://doi.org/10.1067/mge.2003.292
  43. Kogure H, Isayama H, Nakai Y, et al. Newly designed large cell Niti-S stent for malignant hilar biliary obstruction: a pilot study. Surg Endosc 2011;25:463-467. https://doi.org/10.1007/s00464-010-1194-8
  44. 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
  45. Polydorou AA, Chisholm EM, Romanos AA, et al. A comparison of right versus left hepatic duct endoprosthesis insertion in malignant hilar biliary obstruction. Endoscopy 1989;21:266-271. https://doi.org/10.1055/s-2007-1012966
  46. Polydorou AA, Cairns SR, Dowsett JF, et al. Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion. Gut 1991;32:685-689. https://doi.org/10.1136/gut.32.6.685
  47. Deviere J, Baize M, de Toeuf J, Cremer M. Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage. Gastrointest Endosc 1988;34:95-101. https://doi.org/10.1016/S0016-5107(88)71271-7
  48. Ridtitid W, Rerknimitr R, Janchai A, Kongkam P, Treeprasertsuk S, Kullavanijaya P. Outcome of second interventions for occluded metallic stents in patients with malignant biliary obstruction. Surg Endosc 2010;24:2216-2220. https://doi.org/10.1007/s00464-010-0931-3
  49. Hintze RE, Abou-Rebyeh H, Adler A, Veltzke-Schlieker W, Felix R, Wiedenmann B. Magnetic resonance cholangiopancreatography- guided unilateral endoscopic stent placement for Klatskin tumors. Gastrointest Endosc 2001;53:40-46. https://doi.org/10.1067/mge.2001.111388
  50. Sherman S. Endoscopic drainage of malignant hilar obstruction: is one biliary stent enough or should we work to place two? Gastrointest Endosc 2001;53:681-684. https://doi.org/10.1067/mge.2001.114714
  51. Vienne A, Hobeika E, Gouya H, et al. Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment. Gastrointest Endosc 2010;72:728-735. https://doi.org/10.1016/j.gie.2010.06.040
  52. Bulajic M, Panic N, Radunovic M, et al. Clinical outcome in patients with hilar malignant strictures type II Bismuth-Corlette treated by minimally invasive unilateral versus bilateral endoscopic biliary drainage. Hepatobiliary Pancreat Dis Int 2012;11:209-214. https://doi.org/10.1016/S1499-3872(12)60150-7
  53. Motte S, Deviere J, Dumonceau JM, Serruys E, Thys JP, Cremer M. Risk factors for septicemia following endoscopic biliary stenting. Gastroenterology 1991;101:1374-1381.
  54. Naitoh I, Ohara H, Nakazawa T, et al. Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction. J Gastroenterol Hepatol 2009;24:552-557. https://doi.org/10.1111/j.1440-1746.2008.05750.x
  55. Hookey LC, Le Moine O, Deviere J. Use of a temporary plastic stent to facilitate the placement of multiple selfexpanding metal stents in malignant biliary hilar strictures. Gastrointest Endosc 2005;62:605-609. https://doi.org/10.1016/j.gie.2005.04.051
  56. Chen JH, Sun CK, Liao CS, Chua CS. Self-expandable metallic stents for malignant biliary obstruction: efficacy on proximal and distal tumors. World J Gastroenterol 2006;12:119-122. https://doi.org/10.3748/wjg.v12.i1.119
  57. Lee JH, Kang DH, Kim JY, 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
  58. Kanno Y, Ito K, Fujita N, et al. Single-session endoscopic bilateral y-configured placement of metal stents for hilar malignant biliary obstruction. Dig Endosc 2011;23:91-96. https://doi.org/10.1111/j.1443-1661.2010.01048.x
  59. Kim JY, Kang DH, Choi CW, Kim HW, Park SB, Kim DU. Selective intrahepatic duct cannulation by using a triple-lumen catheter for endoscopic bilateral stenting in hilar cholangiocarcinoma. Gastrointest Endosc 2010;72:192-198. https://doi.org/10.1016/j.gie.2010.02.047
  60. Silverman W, Slivka A. New technique for bilateral metal mesh stent insertion to treat hilar cholangiocarcinoma. Gastrointest Endosc 1996;43:61-63. https://doi.org/10.1016/S0016-5107(96)70263-8
  61. Mukai T, Yasuda I, Isayama H, et al. Comparison of axial force and cell width of self-expandable metallic stents: which type of stent is better suited for hilar biliary strictures? J Hepatobiliary Pancreat Sci 2011;18:646-652. https://doi.org/10.1007/s00534-011-0406-5
  62. Park do H, Lee SS, Moon 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
  63. Kim JY, Kang DH, Kim HW, 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
  64. Gerhardt T, Rings D, Hoblinger A, Heller J, Sauerbruch T, Schepke M. Combination of bilateral metal stenting and trans-stent photodynamic therapy for palliative treatment of hilar cholangiocarcinoma. Z Gastroenterol 2010;48:28-32. https://doi.org/10.1055/s-0028-1109983
  65. Chahal P, Baron TH. Expandable metal stents for endoscopic bilateral stent-within-stent placement for malignant hilar biliary obstruction. Gastrointest Endosc 2010;71:195-199. https://doi.org/10.1016/j.gie.2009.08.006
  66. Hwang JC, Kim JH, Lim SG, Kim SS, Yoo BM, Cho SW. Y-shaped endoscopic bilateral metal stent placement for malignant hilar biliary obstruction: prospective longterm study. Scand J Gastroenterol 2011;46:326-332. https://doi.org/10.3109/00365521.2010.536253

피인용 문헌

  1. Stent placement in perihilar cholangiocarcinoma vol.3, pp.4, 2013, https://doi.org/10.1002/cld.323
  2. Hepato-biliary-enteric stent drainage as palliative treatment for proximal malignant obstructive jaundice vol.31, pp.3, 2013, https://doi.org/10.1007/s12032-014-0853-3
  3. Percutaneous transhepatic and endoscopic biliary drainage for malignant biliary tract obstruction: a meta-analysis vol.12, pp.None, 2013, https://doi.org/10.1186/1477-7819-12-272
  4. Is EUS-guided drainage a suitable alternative technique in case of proximal biliary obstruction? vol.10, pp.7, 2013, https://doi.org/10.1177/1756283x17702614
  5. Role of Minimally Invasive Surgery in Cholangiocarcinoma vol.6, pp.3, 2013, https://doi.org/10.5812/minsurgery.61046
  6. Using the stent-in-stent technique to drain the right hepatic duct, passing across a 7-year-old obstructed spiral self-expandable metal stent of the left hepatic duct vol.8, pp.6, 2013, https://doi.org/10.1093/gastro/goaa019