Newly designed large cell Niti-S stent for malignant hilar biliary obstruction: a pilot study
Hirofumi KogureHiroyuki, Hiroyuki Isayama, Yousuke Nakai, Takeshi Tsujino, Yukiko Ito, Keisuke Yamamoto, Suguru Mizuno, Hiroshi Yagioka, Kazumichi Kawakubo, Takashi Sasaki, Kenji Hirano, Naoki Sasahirahttp://academic.research.microsoft.com/io.ashx?type=5&id=33938644&selfId1=0&selfId2=0&maxNumber=12&query=
Background Whether uni- or bilateral drainage should be performed for malignant hilar biliary obstruction remains a matter of debate.
Moreover, endoscopic placement of bilateral metallic stents has been considered difficult and complicated. Although the Y-stent
with a central wide-open mesh facilitates bilateral stent placement, it has limitations. This study evaluated the feasibility
and efficacy of the Niti-S large cell D-type biliary stent (LCD) with a uniform large cell for both uni- and bilateral drainage
of malignant hilar biliary obstruction.
Methods From April 2008 to March 2009, a total of 12 consecutive patients with unresectable malignant hilar biliary obstruction of
Bismuth type 2 or greater underwent placement of LCD. Before LCD placement, all the patients underwent endoscopic unilateral
biliary drainage using a plastic stent or a nasobiliary drainage tube. If jaundice improved after the procedure, the plastic
stent or nasobiliary drainage tube was replaced with the unilateral LCD. If jaundice did not resolve or contralateral cholangitis
occurred, bilateral LCD placement was performed.
Results Seven patients had unilateral and five patients had bilateral LCD placement. Technical success was achieved for all 12 patients.
An early complication occurred for one patient (8%), and stent occlusion occurred for six patients (50%) because of tumor
ingrowth (n = 4) or sludge (n = 2). These patients were managed by insertion of plastic stents (n = 4) or percutaneous transhepatic biliary drainage (n = 2). The median stent patency period was 202 days.
Conclusions The newly designed endoscopic metallic stent may be feasible and effective for malignant hilar biliary obstruction, and endoscopic
reintervention is relatively simple.