| International Session (Workshop) 2 (JGES・JSGE・JSGS) |
| Sat. November 3rd 14:40 - 17:00 Room 13: Kobe International Conference Center International Conference Room |
| Long-term clinical outcomes of endoscopic deployment of multiple metal stents for malignant hilar biliary obstruction | |||
| Ryo Sugiura1, Masaki Kuwatani1, Naoya Sakamoto1 | |||
| 1Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine | |||
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| Background: Endoscopic deployment of multiple metal stents, which includes partial stent-in-stent (SIS) and side-by-side (SBS) methods, is useful for the palliation for malignant hilar biliary obstruction (MHBO). However, the long-term clinical outcomes of the two methods have yet to be determined. Object: To elucidate the long-term clinical outcomes of SIS and SBS. Methods: Between December 2009 and October 2017, 91 patients with MHBO were successfully treated with two metal stents (MSs) (SIS, 57; SBS, 34) in our institute. We enrolled them and evaluated 1) patient characteristics, 2) adverse events, 3) recurrent biliary obstruction (RBO) rates, 4) details of RBO and 5) details of re-intervention. Results: 1) SIS/SBS; the median ages were 70/72, and male rates were 61.4/58.8%. Bismuth-Corlette classification I/ II / IIIa/ IIIb/ IV: 2/21/9/9/16 (SIS); 1/6/8/6/13 (SBS). The primary diseases were cholangiocarcinoma, 28/22; gallbladder cancer, 26/9; metastatic cnacer, 3/2; hepatocellular carcinoma, 0/1. 2) The adverse events were 14(24.6%)/10(29.4%) (cholangitis, 7/6; pancreatitis, 3/3; cholecystitis, 3/1; liver abscess, 1/0). 3) RBO rates at 1 year were 61.3/44.0%, which were not significantly different by the competing risk analysis (P=0.12). 4) RBO occurred in 28 SIS (49.1%) (ingrowth, 22; sludge, 4; others, 2) and 12 SBS patients (35.3%) (ingrowth, 8; sludge, 2; others, 2). 5) SIS/SBS; re-intervention methods were only endoscopic treatment, 22/9; only percutaneous treatment 1/1; complex treatment 4/2. Conclusions: There were no significant differences of long-term clinical outcomes between SIS and SBS, while the re-intervention rate of SIS tended to be higher. |
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Index Term 1: Malignant hilar biliary obstruction Index Term 2: Recurrent biliary obstruction |
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