Project description:ObjectivesWith the improved prognosis of patients with biliary tract cancer (BTC) owing to advances in chemotherapy, long-term stent patency has become an important goal in patients undergoing biliary stent placement. We compared the duration of stent patency between unresectable BTC patients undergoing multi-stenting for malignant hilar biliary obstruction by the side-by-side (SBS) and stent-in-stent (SIS) techniques during systemic chemotherapy.MethodsWe retrospectively evaluated the data of 62 unresectable BTC patients who underwent multi-stenting before the first or second cycle of first-line chemotherapy. Stent deployment was performed by the SBS technique in 40 patients (SBS group) and by the SIS technique in 22 patients (SIS group).ResultsThe median time-to-recurrent biliary obstruction was 147 days in the SBS group and 252 days in the SIS (p = 0.029), being longer in the SIS group. The rates of development of early adverse events were 28% and 9% (p = 0.09) and the rates of development of late adverse events were 26% and 14% in the SBS and SIS groups (p = 0.27). The median overall survival was 480 days in the SBS group and 563 days in the SIS group (p = 0.92).ConclusionThe duration of stent patency was shorter in the SBS group than in the SIS group; thus, the SIS technique is preferable to the SBS technique for biliary stent deployment in unresectable BTC patients during systemic chemotherapy.

| S-EPMC11803297 | biostudies-literature

Novel J-tip guidewire for reintervention after stent-by-stent placement in patients with malignant hilar biliary obstruction.

Project description: Not available

| S-EPMC9473852 | biostudies-literature

Clinical Outcomes of Bilateral Stent-in-Stent Placement Using Self-Expandable Metallic Stent for High-Grade Malignant Hilar Biliary Obstruction.

Project description:PurposeEndoscopic bile duct decompression using bilateral self-expandable metallic stents (SEMSs) deployed via a stent-in-stent (SIS) method is considered a preferred procedure for malignant hilar biliary obstruction (MHBO). However, occlusion thereof occurs frequently. Here, we investigated stent patency duration and risk factors related to stent obstruction with bilateral SIS placement for MHBO at two large centers.Materials and methodsThe present study reviewed data on patients with MHBO who underwent endoscopic biliary drainage using the SIS method. Clinical outcomes, including stent patency duration and patient overall survival, were analyzed. Factors associated with stent patency were evaluated using Cox proportional hazards models.ResultsSeventy patients with MHBO underwent endoscopic biliary drainage using the SIS method. Median age was 68 years old, and median follow-up duration was 140 days (interquartile range, 57-329). The proportion of high-grade MHBOs (Bismuth type IV) was 57.1%. Median stent patency duration with the SIS method was 108 days according to Kaplan-Meier curves. Median patient survival analyzed by the Kaplan-Meier method was 181 days. Multivariate analysis indicated that higher baseline bilirubin (> 6.1 mg/dL) as an independent risk factor related to stent patency (p<0.05).ConclusionIn endoscopic biliary decompression using SEMS placed with the SIS method, obstructive jaundice was a risk factor for stent patency. The SIS method for high-grade MHBO showed short stent patency.

| S-EPMC6082981 | biostudies-literature

Endoscopic translumen-apposing metal stent biliary stent placement.

Project description: Not available

| S-EPMC5965706 | biostudies-literature

Fishing line assisted endoscopic placement of multiple plastic biliary stents for unresectable malignant hilar biliary obstruction: a retrospective study.

Project description:Background and aimsStent migration is one of the most common complications during the placement of multiple plastic biliary stents (MPBS) under endoscopy. This study aims to evaluate the feasibility and efficiency of the fishing line assisted (FLA) method for preventing the complication.MethodsPatients with unresectable malignant hilar biliary obstruction (MHBO) who undergone endoscopic placement of MPBS using the FLA or conventional method from May 2018 to April 2021 in our center were enrolled in the study. The endpoints of this study were the stent migration rate, technical success rates, adverse events rates, times of stent migration, and the procedure time.ResultsFLA group (N = 19) and conventional group (N = 22) had similar baseline characteristics of the patients. The technical success rates (100% vs. 95.5%; P > 0.05), ERCP-related adverse events rates (5.3% vs. 4.5%; P > 0.05), and the stent-related adverse events rates (0% vs. 4.5%; P > 0.05) were no significant differences between the FLA and conventional groups. MPBS inserted using the conventional method consumed more time (median, 33.9 min vs. 15.6 min; P < 0.05) method and increased the times of stent migration (median, 3 times vs. 0 times; P < 0.05) than using the FLA method. Even if no statistical difference was detected in the stent migration rate between groups, this rate was lower in the FLA group than the conventional group (0% vs. 13.6%; P > 0.05).ConclusionsFLA method is an effective technique for MPBS implantation to prevent stent migration during endoscopic retrograde cholangiography (ERCP). The method should be applied to patients with unresectable MHBO who need to place MPBS.

| S-EPMC8603567 | biostudies-literature

Safety and efficacy of side-by-side versus stent-in-stent stenting for malignant hilar biliary obstruction: a systematic review and meta-analysis

Project description: Not available

| S-EPMC11350534 | biostudies-literature

Hepaticoduodenostomy in Combined Endoscopic Ultrasound-Endoscopic Retrograde Cholangiopancreatography Biliary Drainage for Malignant Hilar Biliary Obstruction.

Project description: Not available

| S-EPMC10993820 | biostudies-literature

Comparison of the hybrid and partial stent-in-stent method for endoscopic three-segment drainage for unresectable malignant hilar biliary obstruction.

Project description:Background and study aims The clinical outcome of the new hybrid drainage method for unresectable malignant hilar biliary obstruction (UMHBO) has not yet been compared with that of the partial stent-in-stent (PSIS) method with three or more stents. Patients and methods Patients with UMHBO underwent drainage of three segments using the hybrid or PSIS method. The clinical outcomes of both methods were compared retrospectively. Results Overall, 54 patients underwent the hybrid (n = 31) or PSIS (n = 23) method of drainage with three or more stents for UMHBO. There were no significant differences in the technical success rate (hybrid vs. PSIS, 87.1 % vs. 87 %), clinical success rate according to per-protocol analysis (81.5 % vs. 70 %), early adverse events rate (14.8 % vs. 10%), late adverse events rate (7.4 % vs. 0 %), and technical success rate of the endoscopic transpapillary reintervention (90.9 % vs. 100 %). Time to recurrent biliary obstruction (TRBO) of the hybrid and PSIS methods was 178 and 231 days, respectively, with no significant difference ( P = 0.354). Conclusions The choice between the two methods should be made at the physician's discretion.

| S-EPMC10036201 | biostudies-literature

Is endoscopic radiofrequency ablation plus stent placement superior to stent placement alone for the treatment of malignant biliary obstruction? A systematic review and meta-analysis.

Project description:ObjectiveMalignant biliary obstruction (MBO) is a rare disease with a poor prognosis. Recent studies have shown that endoscopic radiofrequency ablation (ERFA) may improve survival. We conducted a systematic review and meta-analysis of the efficacy of ERFA in combination with biliary stent placement for the treatment of MBO.MethodsThe study was registered in INPLASY (number 202340096). The PubMed, Cochrane Library, Web of Science, and Embase databases were searched from inception to April 2023. We selected studies comparing the efficacy of ERFA plus stent placement with stent placement alone. The primary outcomes were pooled hazard ratios (HRs) for overall survival and stent patency; the secondary outcomes were the odds ratios (ORs) for adverse events.ResultsEleven studies (four randomized controlled trials and seven observational studies) were included in the meta-analysis. Pooled analysis showed a difference in survival time between the two groups (HR 0.65, 95% confidence interval [CI] 0.58-0.73, I2 = 40%). However, there were no differences in the duration of stent patency or the incidence of adverse events (HR 1.04, 95% CI 0.84-1.29, I2 = 46%; OR 1.41, 95% CI 1.02-1.96, I2 = 29%).ConclusionsERFA has a significant survival benefit for MBO, but does not increase the risk of adverse events.

| S-EPMC10757445 | biostudies-literature

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