| International Session (Workshop) 2 (JGES・JSGE・JSGS) |
| Sat. November 3rd 14:40 - 17:00 Room 13: Kobe International Conference Center International Conference Room |
| Feasibility and effectiveness of side-by-side deployment with the self-expandable metallic stent for the unresectable malignant hilar biliary obstruction | |||
| Toshio Fujisawa1, Hiroaki Saito1, Hiroyuki Isayama1 | |||
| 1Department of Gastroenterology, Juntendo University Hospital | |||
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| [Background] Recently, covered self-expandable metallic stent (c-SEMS) is indicated for the cases with hilar malignant biliary obstruction (H-MBO). We evaluated feasibility and efficacy of c-SEMS comparing with u-SEMS. [Method] We retrospectively examined the clinical results of side-by-side (SBS) placement with SEMS from August 2015 to February 2018. We placed u-SEMS above and c-SEMS across the papilla as SBS fashion, bilaterally. [Results] Six u-SEMS and 15 c-SEMS were placed in 21 cases with H-MBO. Followings are background data; 12 male, 68.4 y.o. (mean) and causative disease were gallbladder cancer (8), extrahepatic cholangiocarcinoma (5), pancreatic cancer (3) and primary/metastatic liver cancer (5). Bismuth classifications were type II (2), III (11) and IV (8). Both technical and clinical success rate were 100% without any adverse event related with insertion procedure, nevertheless c-SEMS were placed for 6 cases of Bismuth type IV. Recurrent biliary obstruction (RBO) was found in 8 cases; 3 occlusions (2 Tumor ingrowth and 1 overgrowth) in u-SEMS, and 4 occlusions (tumor overgrowth) and 1 migration in c-SEMS. Cumulative time to RBO (TRBO) of u-SEMS was significantly shorter than c-SEMS (median 118 vs. 204 days, P=0.009). Removal of c-SEMS was succeeded in all expected cases (3) and new stents were placed when the initial c-SEMS was occluded. [Conclusion] c-SEMS with SBS placement is feasible and effective, and was able to place for the cases with Bismuth type IV. c-SEMS was removable when it was occluded. Larger scale study was warranted to establish this stenting strategy. |
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Index Term 1: side-by-side Index Term 2: malignant hilar stricture |
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