PMID- 36294431
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221030
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 11
IP  - 20
DP  - 2022 Oct 17
TI  - The Feasibility of Whole-Liver Drainage with a Novel 8 mm Fully Covered 
      Self-Expandable Metal Stent Possessing an Ultra-Slim Introducer for Malignant 
      Hilar Biliary Obstructions.
LID - 10.3390/jcm11206110 [doi]
LID - 6110
AB  - BACKGROUND: In the case of an unresectable malignant hilar biliary obstruction 
      (MHBO), the optimal drainage method has not yet been established. Recently, an 8 
      mm, fully covered, self-expandable metal stent (FCSEMS) with an ultra-slim 
      introducer has become available. In this article, the results of whole-liver 
      drainage tests using this novel FCSEMS for MHBO are reported. METHODS: 
      Unresectable MHBOs up to Bismuth IIIa with strictures limited to the secondary 
      branches were eligible. The proximal end of the stent was placed in such a way as 
      to avoid blocking the side branches, and the distal end was placed above the 
      papilla when possible. Consecutive patients treated between April 2017 and 
      January 2021 were retrospectively analyzed. The technical and functional success 
      rates, rates and causes of recurrent biliary obstruction (RBO), time to RBO 
      (TRBO), revision for RBO, and adverse events (AEs) were evaluated. RESULTS: 
      Eleven patients (Bismuth I/II/IIIa: 1/7/3) were enrolled. Two stents were placed 
      in nine patients and three were placed in two patients. Both the technical and 
      functional success rates were 100%. RBO occurred in four (36%) patients due to 
      sludge formation. Revision was performed for three patients, with the successful 
      removal of all stents. The median TRBO was 187 days, and no late AEs other than 
      the RBO occurred. Regarding the distal position of the stent, the RBO rate was 
      significantly lower (14.3% vs. 75%, p = 0.041) and the cumulative TRBO was 
      significantly longer (median TRBO: not reached vs. 80 days, p = 0.031) in the 
      case of the placement above the papilla than the placement across the papilla. 
      CONCLUSION: For unresectable MHBOs of Bismuth I, II, and IIIa, whole-liver 
      drainage with a novel 8 mm FCSEMS possessing an ultra-slim introducer was 
      feasible and potentially safe, with favorable stent patency. Placement above the 
      papilla might be preferrable to placement across the papilla.
FAU - Matsubara, Saburo
AU  - Matsubara S
AD  - Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama 
      Medical University, Saitama 350-8550, Japan.
FAU - Nakagawa, Keito
AU  - Nakagawa K
AD  - Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama 
      Medical University, Saitama 350-8550, Japan.
FAU - Suda, Kentaro
AU  - Suda K
AD  - Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama 
      Medical University, Saitama 350-8550, Japan.
FAU - Otsuka, Takeshi
AU  - Otsuka T
AD  - Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama 
      Medical University, Saitama 350-8550, Japan.
FAU - Oka, Masashi
AU  - Oka M
AD  - Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama 
      Medical University, Saitama 350-8550, Japan.
FAU - Nagoshi, Sumiko
AU  - Nagoshi S
AD  - Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama 
      Medical University, Saitama 350-8550, Japan.
LA  - eng
PT  - Journal Article
DEP - 20221017
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC9605161
OTO - NOTNLM
OT  - endoscopic biliary drainage
OT  - fully covered self-expandable metal stent
OT  - malignant hilar biliary obstruction
COIS- The authors declare no conflict of interest.
EDAT- 2022/10/28 06:00
MHDA- 2022/10/28 06:01
PMCR- 2022/10/17
CRDT- 2022/10/27 01:30
PHST- 2022/08/31 00:00 [received]
PHST- 2022/10/02 00:00 [revised]
PHST- 2022/10/12 00:00 [accepted]
PHST- 2022/10/27 01:30 [entrez]
PHST- 2022/10/28 06:00 [pubmed]
PHST- 2022/10/28 06:01 [medline]
PHST- 2022/10/17 00:00 [pmc-release]
AID - jcm11206110 [pii]
AID - jcm-11-06110 [pii]
AID - 10.3390/jcm11206110 [doi]
PST - epublish
SO  - J Clin Med. 2022 Oct 17;11(20):6110. doi: 10.3390/jcm11206110.