Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Optimal endoscopic drainage strategy for unresectable malignant hilar biliary obstruction

  • Itaru Naitoh (Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences) ;
  • Tadahisa Inoue (Department of Gastroenterology, Aichi Medical University)
  • Received : 2022.05.16
  • Accepted : 2022.06.28
  • Published : 2023.03.30
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Abstract

Endoscopic biliary drainage strategies for managing unresectable malignant hilar biliary obstruction differ in terms of stent type, drainage area, and deployment method. However, the optimal endoscopic drainage strategy remains unclear. Uncovered self-expandable metal stents (SEMS) are the preferred type because of their higher functional success rate, longer time to recurrent biliary obstruction (RBO), and fewer cases of reintervention than plastic stents (PS). Other PS subtypes and covered SEMS, which feature a longer time to RBO than PS, can be removed during reintervention for RBO. Bilateral SEMS placement is associated with a longer time to RBO and a longer survival time than unilateral SEMS placement. Unilateral drainage is acceptable if a drainage volume of greater than 50% of the total liver volume can be achieved. In terms of deployment method, no differences were observed in clinical outcomes between side-by-side (SBS) and stent-in-stent deployment. Simultaneous SBS boasts a shorter procedure time and higher technical success rate than sequential SBS. This review of previous studies aimed to clarify the optimal endoscopic biliary drainage strategy for unresectable malignant hilar biliary obstruction.

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References

  1. Larghi A, Tringali A, Lecca PG, et al. Management of hilar biliary strictures. Am J Gastroenterol 2008;103:458-473.
  2. Moole H, Dharmapuri S, Duvvuri A, et al. Endoscopic versus percutaneous biliary drainage in palliation of advanced malignant hilar obstruction: a meta-analysis and systematic review. Can J Gastroenterol Hepatol 2016;2016:4726078.
  3. Wang L, Lin N, Xin F, et al. A systematic review of the comparison of the incidence of seeding metastasis between endoscopic biliary drainage and percutaneous transhepatic biliary drainage for resect-able malignant biliary obstruction. World J Surg Oncol 2019;17:116.
  4. Nakai Y, Kogure H, Isayama H, et al. Endoscopic ultrasound-guided biliary drainage for unresectable hilar malignant biliary obstruction. Clin Endosc 2019;52:220-225.
  5. Sundaram S, Dhir V. EUS-guided biliary drainage for malignant hilar biliary obstruction: a concise review. Endosc Ultrasound 2021;10:154-160.
  6. Wagner HJ, Knyrim K, Vakil N, et al. Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction: a prospective and randomized trial. Endoscopy 1993;25:213-218.
  7. Sawas T, Al Halabi S, Parsi MA, et al. Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis. Gastrointest Endosc 2015;82:256-267.
  8. Almadi MA, Barkun A, Martel M. Plastic vs. self-expandable metal stents for palliation in malignant biliary obstruction: a series of meta-analyses. Am J Gastroenterol 2017;112:260-273.
  9. Inatomi O, Bamba S, Shioya M, et al. Threaded biliary inside stents are a safe and effective therapeutic option in cases of malignant hilar obstruction. BMC Gastroenterol 2013;13:31.
  10. Ishiwatari H, Hayashi T, Ono M, et al. Newly designed plastic stent for endoscopic placement above the sphincter of Oddi in patients with malignant hilar biliary obstruction. Dig Endosc 2013;25 Suppl 2:94-99.
  11. Kaneko T, Sugimori K, Shimizu Y, et al. Efficacy of plastic stent placement inside bile ducts for the treatment of unresectable malignant hilar obstruction (with videos). J Hepatobiliary Pancreat Sci 2014;21:349-355.
  12. Kurita A, Uza N, Asada M, et al. Stent placement above the sphincter of Oddi is a useful option for patients with inoperable malignant hilar biliary obstruction. Surg Endosc 2022;36:2869-2878.
  13. Mukai T, Yasuda I, Nakashima M, et al. Metallic stents are more efficacious than plastic stents in unresectable malignant hilar biliary strictures: a randomized controlled trial. J Hepatobiliary Pancreat Sci 2013;20:214-222.
  14. Sangchan A, Kongkasame W, Pugkhem A, et al. Efficacy of metal and plastic stents in unresectable complex hilar cholangiocarcinoma: a randomized controlled trial. Gastrointest Endosc 2012;76:93-99.
  15. Xia MX, Pan YL, Cai XB, et al. Comparison of endoscopic bilateral metal stent drainage with plastic stents in the palliation of unresectable hilar biliary malignant strictures: large multicenter study. Dig Endosc 2021;33:179-189.
  16. Inoue T, Okumura F, Naitoh I, et al. Feasibility of the placement of a novel 6-mm diameter threaded fully covered self-expandable metal stent for malignant hilar biliary obstructions (with videos). Gastrointest Endosc 2016;84:352-357.
  17. Yoshida T, Hara K, Imaoka H, et al. Benefits of side-by-side deployment of 6-mm covered self-expandable metal stents for hilar malignant biliary obstructions. J Hepatobiliary Pancreat Sci 2016;23:548-555.
  18. Kitamura K, Yamamiya A, Ishii Y, et al. Side-by-side partially covered self-expandable metal stent placement for malignant hilar biliary obstruction. Endosc Int Open 2017;5:E1211-E1217.
  19. 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.
  20. Takahashi E, Fukasawa M, Sato T, et al. Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry. World J Gastroenterol 2015;21:4946-4953.
  21. De Palma GD, Galloro G, Siciliano S, et al. 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.
  22. 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.
  23. Iwano H, Ryozawa S, Ishigaki N, et al. Unilateral versus bilateral drainage using self-expandable metallic stent for unresectable hilar biliary obstruction. Dig Endosc 2011;23:43-48.
  24. Liberato MJ, Canena JM. Endoscopic stenting for hilar cholangiocarcinoma: efficacy of unilateral and bilateral placement of plastic and metal stents in a retrospective review of 480 patients. BMC Gastroenterol 2012;12:103.
  25. Lee TH, Kim TH, Moon JH, et al. Bilateral versus unilateral placement of metal stents for inoperable high-grade malignant hilar biliary strictures: a multicenter, prospective, randomized study (with video). Gastrointest Endosc 2017;86:817-827.
  26. Staub J, Siddiqui A, Murphy M, et al. Unilateral versus bilateral hilar stents for the treatment of cholangiocarcinoma: a multicenter international study. Ann Gastroenterol 2020;33:202-209.
  27. Xia MX, Cai XB, Pan YL, et al. Optimal stent placement strategy for malignant hilar biliary obstruction: a large multicenter parallel study. Gastrointest Endosc 2020;91:1117-1128.
  28. 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.
  29. Law R, Baron TH. Bilateral metal stents for hilar biliary obstruction using a 6Fr delivery system: outcomes following bilateral and sideby-side stent deployment. Dig Dis Sci 2013;58:2667-2672.
  30. Kawakubo K, Kawakami H, Kuwatani M, et al. Single-step simultaneous side-by-side placement of a self-expandable metallic stent with a 6-Fr delivery system for unresectable malignant hilar biliary obstruction: a feasibility study. J Hepatobiliary Pancreat Sci 2015;22:151-155.
  31. Inoue T, Ishii N, Kobayashi Y, et al. Simultaneous versus sequential side-by-side bilateral metal stent placement for malignant hilar biliary obstructions. Dig Dis Sci 2017;62:2542-2549.
  32. 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.
  33. Inoue T, Naitoh I, Suzuki Y, et al. Multi-center study of endoscopic revision after side-by-side metal stent placement for malignant hilar biliary obstruction. Dig Endosc 2021;33:807-814.
  34. 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.
  35. 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.
  36. Lee JM, Lee SH, Chung KH, et al. Small cell- versus large cell-sized metal stent in endoscopic bilateral stent-in-stent placement for malignant hilar biliary obstruction. Dig Endosc 2015;27:692-699.
  37. Naitoh I, Nakazawa T, Ban T, et al. 8-mm versus 10-mm diameter self-expandable metallic stent in bilateral endoscopic stent-in-stent deployment for malignant hilar biliary obstruction. J Hepatobiliary Pancreat Sci 2015;22:396-401.
  38. Okuno M, Mukai T, Iwashita T, et al. Evaluation of endoscopic reintervention for self-expandable metallic stent obstruction after stent-in-stent placement for malignant hilar biliary obstruction. J Hepatobiliary Pancreat Sci 2019;26:211-218.
  39. Lee TH, Moon JH, Choi JH, et al. Prospective comparison of endoscopic bilateral stent-in-stent versus stent-by-stent deployment for inoperable advanced malignant hilar biliary stricture. Gastrointest Endosc 2019;90:222-230.
  40. Kim KM, Lee KH, Chung YH, et al. A comparison of bilateral stenting methods for malignant hilar biliary obstruction. Hepatogastroenterology 2012;59:341-346.
  41. Naitoh I, Hayashi K, Nakazawa T, et al. Side-by-side versus stent-in-stent deployment in bilateral endoscopic metal stenting for malignant hilar biliary obstruction. Dig Dis Sci 2012;57:3279-3285.
  42. Ishigaki K, Hamada T, Nakai Y, et al. Retrospective comparative study of side-by-side and stent-in-stent metal stent placement for hilar malignant biliary obstruction. Dig Dis Sci 2020;65:3710-3718.