To discuss the indication,
technique and clinical outcome of percutaneous multiple self-expanding metallic stent (SEMS) placement in those patients with hilar malignant biliary stricture.
To make a retrospective analysis of the procedures carried out at our center from January 2017 until September 2018,
in a total of 17 patients.
Most patients with hepatic hilar malignancy are not candidates for curative resection at initial presentation.
In these cases,
palliative biliary drainage may be a reasonable option to relieve symptomatic jaundice,
prevent cholangitis and preserve liver function.
endoscopic drainage is considered the primary treatment but can it be technically challenging in complex hilar tumors,
for which percutaneous drainage is recommended.
SEMS have shown to be superior to plastic stents for palliation in patients with hilar malignancy,
with longer patency and reduced re-intervention.
The main factor...
Findings and procedure details
Before attempting biliary drainage,
and ductal anatomy need to be assessed with noninvasive imaging.
Percutaneous multiple stent placement can be carried out via a single route,
often limited by anatomical factors or via different routes,
which may lead to additional morbidity.
particularly in the atrophic area,
should be avoided to reduce the risk of cholangitis.
There are different techniques for multiple stent placement: the side-by-side,
stent-in-stent (T or Y configuration,
criss-cross) or side-to-end:
In the side-by-side technique,
Percutaneous multiple stent placement with palliative purpose is a reasonable option in some cases of malignant hilar biliary obstruction,
highly effective in terms of technical and clinical success,
but not exempt of complications.
The target for palliative stenting should be adequate drainage of 50% or more of the total liver volume,
regardless of unilateral,
or multisegmental stenting is needed.
It is essential to make an adequate anatomical assessment and technical planning prior to intervention.
Brian T.; BIRK,
An update to hepatobiliary stents.Journal of clinical and translational hepatology,
Tae Hoon; MOON,
Jong Ho; PARK,
Bilateral metallic stenting in malignant hilar obstruction.Clinical endoscopy,
Topic controversies in the endoscopic management of malignant hilar strictures using metal stent: side‐by‐side versus stent‐in‐stent techniques.Journal of Hepato‐Biliary‐Pancreatic Sciences,
Multiple metallic stents...