• Hirofumi Kogure, Hiroyuki Isayama, Yousuke Nakai, Takeshi Tsujino, Saburo Matsubara, Yoko Yashima, Yukiko Ito, Tsuyoshi Hamada, Naminatsu Takahara, Koji Miyabayashi, Suguru Mizuno, Dai Mohri, Kazumichi Kawakubo, Takashi Sasaki, Natsuyo Yamamoto, Kenji Hirano, Naoki Sasahira, Minoru Tada, and Kazuhiko Koike.
• Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
• Dig Endosc. 2014 Jan 1; 26 (1): 93-9.

BackgroundEndoscopic bilateral self-expandable metallic stent (SEMS) placement in a stent-in-stent method for malignant hilar biliary obstruction is technically challenging. Technical difficulties in the initial placement and reinterventions for stent occlusion are disadvantages inherent to this stent-in-stent method. We previously reported the feasibility of Niti-S large cell D-type biliary stents (LCD). This multicenter prospective consecutive study evaluated the efficacy of bilateral SEMS placement using modified LCD with large and uniform cells, a slimmer delivery system and high radial force.Patients And MethodsFrom July 2010 to June 2011, 26 consecutive patients with unresectable malignant hilar biliary obstruction underwent endoscopic bilateral placement of modified LCD in a stent-in-stent method at three tertiary hospitals. Ten patients had gallbladder cancer, eight had cholangiocarcinoma, four had lymph node metastasis, two had intrahepatic cholangiocarcinoma, and two had liver metastasis.ResultsSingle-session and final technical success rate was 96% and 100%, respectively. Functional success rate was 89%. Stent occlusion occurred in 11 patients (42%) because of sludge (n = 7) or tumor ingrowth (n = 4). Endoscopic bilateral reintervention was technically easy and successful: six patients had stent clearance by balloon sweeping and five had plastic stent placement. According to Kaplan-Meier analysis, median survival and stent patency were 220 days and 157 days, respectively.ConclusionsModified LCD achieved a high technical success rate both in the initial stent-in-stent placement and in bilateral reinterventions in patients with malignant hilar biliary obstruction.© 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.

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