Percutaneous insertion of a novel dedicated metal stent to treat malignant hilar biliary obstruction  

作　　者：Francesco Cortese Fabrizio Acquafredda Andrea Mardighian Maria Teresa Zurlo Valentina Ferraro Riccardo Memeo Stavros Spiliopoulos Riccardo Inchingolo 

机构地区：[1]Interventional Radiology Unit,Miulli Hospital,Acquaviva Delle Fonti 70124,Italy [2]Unit of Hepatobiliary Surgery,Miulli hospital,Acquaviva Delle Fonti 70124,Italy [3]2nd Radiology Department,National and Kapodistrian University of Athens,Chaidari Athens 12461,Greece

出　　处：《World Journal of Gastrointestinal Oncology》2022年第9期1833-1843,共11页世界胃肠肿瘤学杂志（英文版）（电子版）

摘　　要：BACKGROUND Percutaneous bilateral biliary stenting is an established method for the management of unresectable malignant hilar biliary obstruction.AIM To evaluate the efficacy and safety of a novel uncovered biliary stent, specifically designed for hilar reconstruction.METHODS This, single-center, retrospective study included 18 patients(mean age 71 ± 11 years;61.1% male) undergoing percutaneous transhepatic Moving cell stent(MCS) placement for hilar reconstruction using the stent-in-stent technique for malignant biliary strictures, between November 2020 and July 2021. The Patients were diagnosed with cholangiocarcinoma(12/18;66.6%), gallbladder cancer(5/18;27.7%), and colorectal liver metastasis(1/18;5.5%). Primary endpoints were technical(appropriate stent placement) and clinical(relief from jaundice) success. Secondary endpoints included stent patency, overall survival, complication rates and stent-related complications.RESULTS The technical and clinical success rates were 100%(18/18 cases). According to Kaplan-Meier analysis, the estimated overall patient survival was 80.5% and 60.4% at 6 and 12 mo respectively, while stent patency was 90.9% and 68.2% at 6 mo and 12 mo respectively. The mean stent patency was 172.53 ± 56.20 d and median stent patency was 165 d(range 83-315). Laboratory tests for cholestasis significantly improved after procedure: mean total bilirubin decreased from 15.2 ± 6.0 mg/d L to 1.3 ± 0.4 mg/d L(P < 0.001);mean γGT decreased from 1389 ± 832 U/L to 114.6 ± 53.5 U/L(P < 0.001). One periprocedural complication was reported. Stent-related complications were observed in 5 patients(27.7%), including 1 occlusion(5.5%) and 1 stent migration(5.5 %).CONCLUSION Percutaneous hilar bifurcation biliary stenting with the MCS resulted in excellent clinical and technical success rates, with acceptable complication rates. Further studies are needed to confirm these initial positive results.

关 键 词：Malignant hilar biliary obstructions Hilar cholangiocarcinoma Self-expandable metallic stent Stent-in-stent technique Percutaneous approach Bilateral Y-stenting 

分 类 号：R735[医药卫生—肿瘤]