Journal List > J Korean Soc Radiol > v.68(4) > 1087239

TOOLS
Koh, Jin, Hwang, Choi, Song, Han, and Kwon: A Comparison of Y-Type and T-Type Metallic Bilateral Biliary Stents in Patients with Malignant Hilar Biliary Obstruction
Interventional Radiology
Journal of the Korean Society of Radiology

Journal of the Korean Society of Radiology 2013; 68(4): 297-303.

Published online: 10 April 2013

DOI: https://doi.org/10.3348/jksr.2013.68.4.297

A Comparison of Y-Type and T-Type Metallic Bilateral Biliary Stents in Patients with Malignant Hilar Biliary Obstruction

Esther Koh, MD1, Gong Yong Jin, MD1, 2, Seung Bae Hwang, MD1, 2, Eun Jung Choi, MD1, Ji Soo Song, MD1, Young Min Han, MD1, 2, 3, Keun Sang Kwon, MD4

1Department of Radiology, Chonbuk National University Hospital and Medical School, Jeonju, Korea.

2Institute of Medical Science, Chonbuk National University Hospital and Medical School, Jeonju, Korea.

3Institute of Cardiovascular Research, Chonbuk National University Hospital and Medical School, Jeonju, Korea.

4Department of Preventive Medicine, Chonbuk National University Hospital and Medical School, Jeonju, Korea.

Corresponding author: Young Min Han, MD. Department of Radiology, Institute of Medical Science, Institute of Cardiovascular Research, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 561-712, Korea. Tel. 82-63-250-1176, Fax. 82-63-272-0481, ymhan@jbnu.ac.kr

Received 10 December 2012       Accepted 24 January 2013

Copyright © 2013 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the Y type (side-by-side) and T type (stent-in-stent) bilateral biliary metal stenting in malignant hilar obstruction in terms of treatment outcomes, including post-stenting serum bilirubin level and stent patency.

Materials and Methods

41 consecutive patients with advanced hilar malignancies who underwent percutaneous placement of bilateral metallic stents - Y (n = 23) and T types (n = 18) - were retrospectively reviewed. We evaluated stent patency after the procedure by cholangiogram and abdominal CT. Pre- and post-stenting serum bilirubin level (total, direct bilirubin) at 1 week and at 1 month were compared. Student t-test and Kaplan-Meier method were used in the statistical analysis.

Results

After comparing the median stent patency according to both types, they did not differ significantly (Y: 38 days, T: 61 days; p = 0.141). There was a more decrease in the total and direct bilirubin of the T type compared to the Y type after 1 week (p = 0.013, 0.025). However, no significant difference existed between the decreasing bilirubin rates of both types after 1 month (p = 0.923, 0.742).

Conclusion

In patients with malignant hilar obstruction, both Y and T type bilateral metallic biliary stents are effective methods. Stent patency and bilirubin decrease rates were not significantly different.

Keywords: Hilar Malignancy, Metallic Biliary Stent, Side-by-Side, Stent-in-Stent

References

1. Han YM, Kwak HS, Jin GY, Lee SO, Chung GH. Treatment of malignant biliary obstruction with a PTFE-covered self-expandable nitinol stent. Korean J Radiol. 2007. 8:410–417.
2. Kim KR, Kim JH, Park WK, Jang JC, Cho JH, Kim TN, et al. The effect of percutaneous bilateral metalic stent for hilar cholangiocarcinoma. Yeungnam Univ J Med. 2005. 22:211–220.
3. Inal M, Akgül E, Aksungur E, Seydaoğlu G. Percutaneous placement of biliary metallic stents in patients with malignant hilar obstruction: unilobar versus bilobar drainage. J Vasc Interv Radiol. 2003. 14:1409–1416.
4. Abraham NS, Barkun JS, Barkun AN. Palliation of malignant biliary obstruction: a prospective trial examining impact on quality of life. Gastrointest Endosc. 2002. 56:835–841.
5. Laméris JS, Stoker J, Nijs HG, Zonderland HM, Terpstra OT, van Blankenstein M, et al. Malignant biliary obstruction: percutaneous use of self-expandable stents. Radiology. 1991. 179:703–707.
6. Lee BH, Choe DH, Lee JH, Kim KH, Chin SY. Metallic stents in malignant biliary obstruction: prospective long-term clinical results. AJR Am J Roentgenol. 1997. 168:741–745.
7. Hwang GH, You JJ, Ahn IO, Na JB, Chung SH. Management of advanced hilar biliary malignancy with X-shaped stenting technique. J Korean Radiol Soc. 2000. 42:919–924.
8. Kim YJ, Kim WH, Yang GS, Kim SW. Treatment of malignant biliar obstruction with wallstent endoprosthesis. J Korean Radiol Soc. 1995. 32:71–76.
9. Bulajic M, Panic N, Radunovic M, Scepanovic R, Perunovic R, Stevanovic P, et al. Clinical outcome in patients with hilar malignant strictures type II Bismuth-Corlette treated by minimally invasive unilateral versus bilateral endoscopic biliary drainage. Hepatobiliary Pancreat Dis Int. 2012. 11:209–214.
10. Deviere J, Baize M, de Toeuf J, Cremer M. Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage. Gastrointest Endosc. 1998. 34:95–101.
11. Jeon YS, Kim JH. T-configured dual stent placement in malignant biliary hilar obstruction: technique and clinical application. J Korean Soc Radiol. 2010. 62:211–218.
12. Kim KM, Lee KH, Chung YH, Shin JU, Lee JK, Lee KT, et al. A comparison of bilateral stenting methods for malignant hilar biliary obstruction. Hepatogastroenterology. 2012. 59:341–346.
13. Naitoh I, Hayashi K, Nakazawa T, Okumura F, Miyabe K, Shimizu S, et al. Side-by-side versus stent-in-stent deployment in bilateral endoscopic metal stenting for malignant hilar biliary obstruction. Dig Dis Sci. 2012. 57:3279–3285.
14. Hong HP, Kim SK, Seo TS. Percutaneous metallic stents in patients with obstructive jaundice due to hepatocellular carcinoma. J Vasc Interv Radiol. 2008. 19:748–754.
15. Li Sol Y, Kim CW, Jeon UB, Lee NK, Kim S, Kang DH, et al. Early infectious complications of percutaneous metallic stent insertion for malignant biliary obstruction. AJR Am J Roentgeno. 2010. 194:261–265.
16. Stoker J, Laméris JS. Complications of percutaneously inserted biliary Wallstents. J Vasc Interv Radiol. 1993. 4:767–772.
17. Kim CW, Park AW, Won JW, Kim S, Lee JW, Lee SH. T-configured dual stent placement in malignant biliary hilar duct obstructions with a newly designed stent. J Vasc Interv Radio. 2004. 15:713–717.
18. Gwon DI, Ko GY, Yoon HK, Kim YJ, Kim TH, Lee WH, et al. Safety and efficacy of percutaneous Y-configured covered stent placement for malignant hilar biliary obstruction: a prospective, pilot study. J Vasc Interv Radiol. 2012. 23:528–534.
19. Han YM, Jin GY, Lee SO, Kwak HS, Chung GH. Flared polyurethane-covered self-expandable nitinol stent for malignant biliary obstruction. J Vasc Interv Radiol. 2003. 14:1291–1301.
20. Eum JS, Kang DH, Choi CW. A preliminary study on the usefullness of a zilver stent for bilateral stenting in patients with advanced hilar cholangiocarcinoma. Korean J Gastrointest Endosc. 2008. 36:354–360.
21. Kogure H, Isayama H, Kawakubo K, Sasaki T, Yamamoto N, Hirano K, et al. Endoscopic bilateral metallic stenting for malignant hilar obstruction using newly designed stents. J Hepatobiliary Pancreat Sci. 2011. 18:653–657.
22. Gwon DI, Ko GY, Yoon HK, Kim JH, Lee JM, Ohm JY, et al. Prospective evaluation of a newly designed T-configured stent graft system for palliative treatment of advanced hilar malignant biliary obstructions. J Vasc Interv Radiol. 2010. 21:1410–1418.
23. Lee TH, Park DH, Lee SS, Choi HJ, Lee JK, Kim TH, et al. Technical Feasibility and Revision Efficacy of the Sequential Deployment of Endoscopic Bilateral Side-by-Side Metal Stents for Malignant Hilar Biliary Strictures: A Multicenter Prospective Study. Dig Dis Sci. 2012. Epub ahead of print.
TOOLS
Similar articles