| セッション情報 |
International Session6(消化器内視鏡学会・消化器病学会合同)
Strategy of biliary drainage for hilar biliary strictures
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| タイトル |
内IS6-7追：Endoscopic Bilateral Stent-in-stent Placement with Modified Large Cell Niti-S Stents for Malignant Hilar Biliary Obstruction
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| 演者 |
H. Kogure（Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of TokyoDELIMITERDepartment of Gastroenterology, Graduate School of Medicine, The University of Tokyo） |
| 共同演者 |
H. Isayama（Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo）, K. Koike（Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo） |
| 抄録 |
Background: Endoscopic bilateral self-expandable metallic stent (SEMS) placement in a stent-in-stent method for malignant hilar biliary obstruction is technically challenging. Technical difficulties in the initial placement and reinterventions for stent occlusion are disadvantages inherent to this stent-in-stent method. We previously reported the feasibility of Niti-S large cell D-type biliary stents (LCD). This study evaluated the efficacy of bilateral SEMS placement using modified LCD with large and uniform cells, a slimmer delivery system and high radial force.Methods: Forty consecutive patients with unresectable malignant hilar biliary obstruction underwent endoscopic bilateral placement of modified LCD in a stent-in-stent method.Results: Single-session and final technical success rate was 95% and 100%, respectively. Functional success rate was 93%. Stent occlusion occurred in 14 patients (35%) because of sludge (n = 8), tumor ingrowth (n = 5), or tumor bleeding (n = 1). Endoscopic bilateral reintervention was technically easy and successful: 7 patients had stent clearance by balloon sweeping and 7 had plastic stent placement. According to the Kaplan-Meier analysis, median survival and stent patency were 220 days and 169 days, respectively.Conclusions: Modified LCD achieved a high technical success rate both in the initial stent-in-stent placement and in bilateral reinterventions in patients with malignant hilar biliary obstruction. |
| 索引用語 |
bilateral biliary drainage, self-expandable metallic stent |
