scholarly journals Endoscopic Stenting in Hilar Cholangiocarcinoma: When, How, and How Much to Drain?

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Andrea Tringali ◽  
Ivo Boškoski ◽  
Guido Costamagna
Keyword(s):  
Biliary Drainage ◽  
Hilar Cholangiocarcinoma ◽  
Liver Volume ◽  
Side Branch ◽  
Plastic Stents ◽  
Metal Stents ◽  
Endoscopic Drainage ◽  
Endoscopic Stenting ◽  
Septic Complications ◽  
Increased Risk

Hilar cholangiocarcinoma (HCCA) involves a complex anatomical region where bile ducts, arteries, and veins create a complex network. HCCA can lead to biliary strictures at the main hepatic confluence, involving the right and left radicles. Endoscopic drainage of jaundiced patients with HCCA is challenging and carries a high risk of infective complications. HCCA needs a careful multidisciplinary evaluation to assess the indication and purposes (preoperative/palliative) of the biliary drainage. Biliary drainage in HCCA needs to be planned by magnetic resonance cholangiography in order to study the biliary anatomy and perform a target drainage of the intrahepatic ducts above the malignant hilar stricture; all the opacified intrahepatic ducts above the hilar stricture must be drained to reduce septic complications. Drainage of >50% of the liver volume is important to obtain bilirubin reduction and less complications, but atrophic liver segments (identified by CT scan) do not require drainage due to the increased risk of cholangitis. When preoperative biliary drainage is planned, plastic stents must be inserted. Self-expandable metal stents are indicated for palliative purposes and should be placed only when a complete liver drainage is possible; only uncovered metal stents are indicated to drain malignant hilar strictures to avoid side-branch occlusion.

scholarly journals Current Endoscopic Management of Malignant Biliary Stricture

Medicina ◽  
2020 ◽  
Vol 56 (3) ◽  
pp. 114
Author(s):  
Chi-Chih Wang ◽  
Tzu-Wei Yang ◽  
Wen-Wei Sung ◽  
Ming-Chang Tsai
Keyword(s):  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Biliary Stricture ◽  
Plastic Stents ◽  
Endoscopic Management ◽  
Metal Stents ◽  
Endoscopic Stenting ◽  
Endoscopic Biliary Drainage ◽  
Stent Patency ◽  
Malignant Biliary Stricture

Biliary and pancreatic cancers occur silently in the initial stage and become unresectable within a short time. When these diseases become symptomatic, biliary obstruction, either with or without infection, occurs frequently due to the anatomy associated with these cancers. The endoscopic management of these patients has changed, both with time and with improvements in medical devices. In this review, we present updated and integrated concepts for the endoscopic management of malignant biliary stricture. Endoscopic biliary drainage had been indicated in malignant biliary obstruction, but the concept of endoscopic management has changed with time. Although routine endoscopic stenting should not be performed in resectable malignant distal biliary obstruction (MDBO) patients, endoscopic biliary drainage is the treatment of choice for palliation in unresectable MDBO patients. Self-expanding metal stents (SEMS) have better stent patency and lower costs compared with plastic stents (PS). For malignant hilum obstruction, PS and uncovered SEMS yield similar short-term outcomes, while a covered stent is not usually used due to a potential unintentional obstruction of contralateral ducts.

Sa1435 HILAR PLASTIC STENTS EXCHANGED AT REGULAR INTERVALS IMPROVE SURVIVAL IN PATIENTS WITH INOPERABLE HILAR CHOLANGIOCARCINOMA WHEN COMPARED TO METAL STENTS

2019 ◽  
Vol 89 (6) ◽  
pp. AB229
Author(s):  
Daniel Lew ◽  
Ebrahim Mirakhor ◽  
rachel perry ◽  
Vicki Wang ◽  
Kenneth H. Park ◽  
...  
Keyword(s):  
Hilar Cholangiocarcinoma ◽  
Plastic Stents ◽  
Metal Stents

Multidisciplinary Approach to Malignant Biliary Obstruction

2020 ◽  
Vol 04 (03) ◽  
pp. 323-333
Author(s):  
Derek Taeyoung Kim ◽  
Uzma Rahman ◽  
Robert W. Tenney ◽  
Oleandro A. Cercio Roa ◽  
Pawan Rastogi ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Multidisciplinary Approach ◽  
Percutaneous Transhepatic Cholangiography ◽  
Preoperative Biliary Drainage ◽  
Malignant Biliary Obstruction ◽  
Plastic Stents ◽  
Metal Stents ◽  
Covered Stents ◽  
Case Examples

AbstractTreatment of malignant biliary obstruction (MBO) requires the coordination of multiple specialties, including oncologists, surgeons, gastroenterologists, and interventional radiologists. If the tumor is resectable, surgical candidates can usually proceed to surgery without preoperative biliary drainage. For patients who undergo biliary drainage, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) combined with biliary stenting are techniques with comparable technical success and mortality, each with distinct advantages and risks. Advances in endoscopic ultrasound allow drainage in patients with challenging anatomy. There are a multitude of devices used for biliary decompression. Self-expanding metal stents (SEMS), with longer patency rates, are in most instances preferred over plastic stents for MBO, especially in patients with life expectancy more than 3 to 4 months. Advantages of covered SEMS versus uncovered SEMS remain controversial as covered stents can prevent tumor ingrowth but at the expense of potential increase in stent migrations. Extra-anatomic biliary drainage using lumen-apposing metal stents is an emerging technique which shows promise when conventional ERCP fails. It is imperative to understand these techniques when tailoring a treatment strategy. The goal of this article is to discuss a multidisciplinary approach for MBO to promote comprehensive care using case examples to highlight essential principles.

scholarly journals Safety and efficacy of self-expanding metal stents for biliary drainage in patients receiving neoadjuvant therapy for pancreatic cancer

2018 ◽  
Vol 06 (06) ◽  
pp. E714-E721 ◽  
Author(s):  
Darren Ballard ◽  
Syed Rahman ◽  
Brian Ginnebaugh ◽  
Abdul Khan ◽  
Kulwinder Dua
Keyword(s):  
Pancreatic Cancer ◽  
Neoadjuvant Therapy ◽  
Biliary Drainage ◽  
Plastic Stents ◽  
Metal Stents ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Safety And Efficacy ◽  
Tertiary Center ◽  
Self Expanding Metal Stents

Abstract Background and study aims Durable biliary drainage is essential during neoadjuvant therapy (NAT) in patients with pancreatic cancer who present with biliary obstruction. Plastic stents (PS) tend to occlude readily, resulting in delay/interruption of treatment. Our aim was to evaluate the safety and efficacy of self-expanding metal stents (SEMS) for biliary drainage in patients receiving NAT for pancreatic cancer. Patients and methods From 2009 to 2014, all consecutive patients with resectable pancreatic cancer at one tertiary center had SEMS placed for biliary drainage before NAT was started. Data on biliary drainage efficacy, stent malfunction rates and procedural adverse events were collected. Results One hundred forty-two consecutive patients with pancreatic cancer (mean age 66 ± 9 SD years; 81 male, 61 female; 67 resectable, 75 borderline resectable) were enrolled. Eight-seven patients (61 %) had prior PS exchanged to SEMS and 55 (39 %) had SEMS placed upfront. Median duration from SEMS placement to the end of NAT/surgery was 111 days (range 44 – 282). During NAT, SEMS malfunction requiring reintervention occurred in 16 patients (11.2 %): tissue ingrowth 11, stent occlusion from food 6, stent migration 3, incomplete expansion 1, “tissue cheese-cutter” effect 1, and cystic duct obstruction 1. On subgroup analysis, no correlation between SEMS malfunction and stage of disease, prior PS, or duration of NAT was found (r2 = 0.05, P = 0.34). Presence of SEMS in situ did not affect pancreaticoduodenectomy. Conclusion SEMS provide safe, effective and durable biliary drainage during NAT for pancreas cancer. Previously placed PS can be exchanged for SEMS. SEMS do not require removal prior to surgery.Meeting presentations: Digestive Disease Week 2015 and 2017

scholarly journals Plastic stents are more cost-effective than lumen-apposing metal stents in management of pancreatic pseudocysts

2018 ◽  
Vol 06 (07) ◽  
pp. E780-E788 ◽  
Author(s):  
Yen-I Chen ◽  
Mouen Khashab ◽  
Viviane Adam ◽  
Ge Bai ◽  
Vikesh Singh ◽  
...  
Keyword(s):  
Cost Effective ◽  
Sensitivity Analyses ◽  
Plastic Stents ◽  
Pancreatic Pseudocysts ◽  
Metal Stents ◽  
Endoscopic Drainage ◽  
Success Rates ◽  
Initial Management ◽  
Pancreatic Fluid ◽  
Fluid Collections

Abstract Background and study aims Endoscopic ultrasound-guided drainage is an effective and accepted primary modality for management of pancreatic pseudocyst (PP). A lumen-apposing metal stent (LAMS) has recently been developed specifically for drainage of pancreatic fluid collections which may be superior to using traditional plastic stents (PS) but is more expensive. Because use of a stent involves a risk of unplanned endoscopy, percutaneous drainage (PCD) and surgery, their costs should also be included in the comparison and a cost-effectiveness analysis of LAMS and PS should therefore be performed Patients and methods A decision tree was developed assessing both endoscopic drainage strategies for patients with PP: LAMS and PS over a 6-month time horizon. For each strategy, inpatients received a stent and were followed for subsequent need for direct further interventions or adverse events leading to unplanned endoscopy, PCD, surgery, or successful endoscopic drainage using probabilities obtained from the literature. The unit of effectiveness was successful endoscopic drainage without need for PCD or surgery. Sensitivity analyses were performed. Results Success rates were 93.9 % for LAMS and 96.96 % for PS. Respective costs per successful drainage were US $ 18,129 (LAMS) and US $ 10,403 (PS). The LAMS strategy was thus characterized as dominated by the PS approach because it was costlier and less effective than PS. Both deterministic and probabilistic sensitivity analyses confirmed the robustness of these findings. Conclusion Use of LAMS is not less effective and more costly than PS in management of patients with PP. As such, PS should be preferred over LAMS as initial management of these patients.

Sign in / Sign up

Export Citation Format

Share Document