Endoscopy 2016; 48(12): 1129-1133
DOI: 10.1055/s-0042-112574
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Third metal stent for revision of malignant hilar biliary strictures

Tae Hoon Lee
1   Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Cheonan, Republic of Korea
,
Jong Ho Moon
2   Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Republic of Korea
,
Hyun Jong Choi
2   Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Republic of Korea
,
Yun Nah Lee
2   Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Republic of Korea
,
Moon Han Choi
2   Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Republic of Korea
,
Sang Woo Cha
3   Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Seoul, Republic of Korea
,
Young Deok Cho
3   Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Seoul, Republic of Korea
,
Sang-Heum Park
1   Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Cheonan, Republic of Korea
,
Sun-Joo Kim
1   Digestive Disease Center, Department of Internal Medicine, SoonChunHyang University School of Medicine, Cheonan, Republic of Korea
› Author Affiliations
Further Information

Publication History

submitted: 25 March 2016

accepted after revision: 14 June 2016

Publication Date:
03 August 2016 (online)

Background and study aim: Endoscopic stent-in-stent (SIS) placement of multiple metal stents is technically demanding. In the present study, we explored the technical feasibility and efficacy of endoscopic deployment of a third metal stent to create a triple SIS placement in patients with a bilateral SIS configuration for inoperable high grade malignant hilar biliary stricture (HBS) that had failed clinically.

Methods: Eighteen patients with histologically proven inoperable HBS underwent deployment of an additional third metal stent as a revisionary method after early clinical failure following technically successful bilateral SIS placement using cross-wired metal stents. The main outcome measures were the technical and clinical success rates, and adverse events.

Results: The overall technical and clinical success rates were 88.9 % (16/18) and 87.5 % (14/16), respectively. The early and late complications were cholangitis (n = 2) and cholecystitis (n = 1). Stent occlusion developed in 35.7 % (5/14) of patients in whom a third metal stent for revision of a bilateral SIS configuration was clinically successful. The median (range) times for stent patency and patient survival were 176 days (49 – 372) and 216 days (52 – 384), respectively.

Conclusions: Endoscopic deployment of an additional third metal stent into a bilateral SIS configuration was technically feasible and effective in patients with inoperable high grade malignant HBS in whom bilateral SIS placement had failed clinically.

 
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