scholarly journals The Comparison of Endoscopic Biliary Drainage in Malignant Hilar Obstruction by Cholangiocarcinoma: Bilateral Metal Stents versus Multiple Plastic Stents

Gut and Liver ◽  
2021 ◽  
Author(s):  
Jun Young Kim ◽  
Sang-geul Lee ◽  
Danbee Kang ◽  
Dong Kyu Lee ◽  
Joo Kyung Park ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Plastic Stents ◽  
Metal Stents ◽  
Endoscopic Biliary Drainage ◽  
Malignant Hilar Obstruction

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.

ID: 3526477 BILATERAL BILIARY DRAINAGE FOR MALIGNANT HILAR OBSTRUCTION USING UNCOVERED METAL STENTS: PATIENT DEMOGRAPHICS AND PREDICTORS OF CLINICAL OUTCOMES

2021 ◽  
Vol 93 (6) ◽  
pp. AB124
Author(s):  
Divya M. Chalikonda ◽  
Muhammad H. Bashir ◽  
Ian Holmes ◽  
Shuji Mitsuhashi ◽  
Anand Kumar ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Biliary Drainage ◽  
Metal Stents ◽  
Patient Demographics ◽  
Malignant Hilar Obstruction

FRI-483-Endoscopic biliary drainage in patients with cholangiocarcinoma: Polyethylene versus self-expanding metal stents

2019 ◽  
Vol 70 (1) ◽  
pp. e611
Author(s):  
Torsten Voigtländer ◽  
Schweitzer Nora ◽  
Von Hahn Thomas ◽  
Michael P. Manns ◽  
Arndt Vogel ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Metal Stents ◽  
Endoscopic Biliary Drainage ◽  
Self Expanding 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

Impact of biliary metal and plastic stents on preoperative staging for pancreatic cancer.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 646-646
Author(s):  
Hachem Hachem ◽  
Sanjay S. Reddy ◽  
Jeffrey Tokar ◽  
Eileen O'Halloran ◽  
Jennifer Higa ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Biliary Drainage ◽  
Neoadjuvant Treatment ◽  
Surgical Pathology ◽  
Plastic Stents ◽  
Metal Stents ◽  
Cross Sectional ◽  
Stent Type ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

646 Background: Multiple studies have shown the superiority of biliary metal compared with plastic stents for pre-operative (preop) biliary drainage in pancreatic cancer (PDAC). Despite the importance of preop cross-sectional imaging, particularly in the era of neoadjuvant treatment, there is no data on the impact of such stents on the quality of preop cross-sectional imaging. We hypothesis, that biliary metal stents negatively impact the accuracy of preop cross-sectional imaging in pancreatic cancer, with unknown impact for the adequacy of surgical candidacy. Methods: Data of all patients undergoing pancreatic resection for PDAC between 1/1/2012 and 1/1/2018 was retrospectively abstracted. Clinical staging based on preop cross-sectional imaging following biliary stent placement (within 2 months prior surgical resection) was compared with the surgical pathology (staging gold standard). Accuracy of clinical and surgical pathology staging was compared. Logistic regression was performed to control for biliary stent type, neoadjuvant treatment and patient baseline characteristics including BMI and type of imaging. Results: 312 patients underwent pancreatic resections. 118 patients required preop biliary drainage in setting of PDAC, including 92 ERCPs of which 83 were successful (46 plastic and 37 metal stents). 76 patients underwent neoadjuvant chemoradiation therapy. Surgical pathology revealed following stages: 0 n = 4, 1A n = 5, 1B n = 8, 2A n = 20, 2B n = 24, 3 n = 1, 4 n = 14. 96% underwent preop CT and 4% MRI pancreas protocol imaging. Exact correlation between clinical and surgical pathology was present in only 48% of cases (57% plastic, 46% metal stent), with 28% of clinical T overstaging, 4% clinical T understaging, 16% clinical N understaging and 4% unable to stage due to artefacts. More importantly, 8% patients were incorrectly staged to be surgical candidates (14% plastic, 6% metal). Controlling for stent type, neoadjuvant treatment and BMI did not impact preop cross-sectional imaging accuracy. Conclusions: Despite their impact on preop cross-imaging biliary metal stents did not negatively impact the accuracy and patient selection for surgical candidacy compared with biliary plastic stents in PDAC.

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.

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