Skip to main content
SpringerLink
Log in

Placement of a newly designed partially covered T- or Y-configured self-expanding metallic stent for hilar biliary obstruction: technical note

  • VASCULAR AND INTERVENTIONAL RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

To investigate the technical success, efficacy, and safety of a newly designed partially covered bilateral self-expanding metallic stent (SEMS) in patients with malignant biliary obstruction.

Material and methods

From May 2016 to November 2017, ten patients with malignant hilar biliary stenosis (bismuth type II–IV) underwent stent placement with the newly designed partially covered T/Y-configured SEMS. Technical success, drainage catheter removal, jaundice remission, early and late complications, stent patency, and overall survival were analyzed.

Results

The stent was successfully deployed in all patients. The total bilirubin level significantly decreased one month after stent placement (P < 0.05). Drainage catheter removal rate was 90%. Two cases (20%) experienced early complications (bile duct hemorrhage and cholangitis) and two cases (20%) experienced late complications (hepatic abscess and cholangitis). During the follow-up (mean 276 days; range 57–503 days) stent occlusion occurred in three patients (30%), and two patents died of hepatic failure. The median stent patency and overall survival were 275 days (95% CI 223.8–326.3 days) and 428.9 days (95% CI 347.9–509.8 days), respectively.

Conclusion

The newly designed partially covered T/Y-configured SEMS is technically feasible and clinically effective for biliary trifurcation obstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Asadi H, Hollingsworth R, Pennycooke K et al (2016) A review of percutaneous transhepatic biliary drainage at a tertiary referral centre. Clin Radiol 71:1312

    Article  Google Scholar 

  2. Yang MJ, Kim JH, Hwang JC et al (2018) Prospective multicenter study of the challenges inherent in using large cell-type stents for bilateral stent-in-stent placement in patients with inoperable malignant hilar biliary obstruction. Gut Liver 12:722–727

    Article  Google Scholar 

  3. Jeon CH, Yoon CJ, Seong NJ, Lee H, Hwang JH, Kim J (2018) Percutaneous stent placement for malignant hilar biliary obstruction: a comparison between criss-cross and T-configuration techniques. Clin Radiol 73:412

    Article  Google Scholar 

  4. Jiao D, Huang K, Zhu M et al (2017) Placement of a newly designed Y-configured bilateral self-expanding metallic stent for hilar biliary obstruction: a pilot study. Dig Dis Sci 62:253–263

    Article  CAS  Google Scholar 

  5. Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol 14:S199–202

    Article  Google Scholar 

  6. Sugimoto M, Takagi T, Suzuki R et al (2017) Predictive factors for the failure of endoscopic stent-in-stent self-expandable metallic stent placement to treat malignant hilar biliary obstruction. World J Gastroenterol 23:6273–6280

    Article  Google Scholar 

  7. Hwang JC, Kim JH, Lim SG, Kim SS, Yoo BM, Cho SW (2011) Y-shaped endoscopic bilateral metal stent placement for malignant hilar biliary obstruction: prospective long-term study. Scand J Gastroenterol 46:326–332

    Article  Google Scholar 

  8. Kim DU, Kang DH, Kim GH et al (2013) Bilateral biliary drainage for malignant hilar obstruction using the ‘stent-in-stent’ method with a Y-stent: efficacy and complications. Eur J Gastroenterol Hepatol 25:99–106

    Article  Google Scholar 

  9. Lee JM, Lee SH, Chung KH et al (2015) Small cell- versus large cell-sized metal stent in endoscopic bilateral stent-in-stent placement for malignant hilar biliary obstruction. Dig Endosc 27:692–699

    Article  Google Scholar 

  10. Naitoh I, Nakazawa T, Ban T et al (2015) 8-mm versus 10-mm diameter self-expandable metallic stent in bilateral endoscopic stent-in-stent deployment for malignant hilar biliary obstruction. J Hepatobiliary Pancreat Sci 22:396–401

    Article  Google Scholar 

  11. Heo JY, Lee HS, Son JH, Lee SH, Bang S (2018) Clinical outcomes of bilateral stent-in-stent placement using self-expandable metallic stent for high-grade malignant hilar biliary obstruction. Yonsei Med J 59:827–833

    Article  CAS  Google Scholar 

  12. Gwon DI, Ko GY, Yoon HK et al (2010) Prospective evaluation of a newly designed T-configured stent graft system for palliative treatment of advanced hilar malignant biliary obstructions. J Vasc Interv Radiol 21:1410–1418

    Article  Google Scholar 

  13. Gwon DI, Ko GY, Yoon HK et al (2012) Safety and efficacy of percutaneous Y-configured covered stent placement for malignant hilar biliary obstruction: a prospective, pilot study. J Vasc Interv Radiol 23:528–534

    Article  Google Scholar 

  14. Kang BC, Lee SW, Chung HH (2013) A newly designed Y-shaped covered stent in the palliative treatment of hepatic hilar malignant obstruction: case report. Korean J Radiol 14:97–101

    Article  Google Scholar 

  15. Yoo SS, Jeong S, Lee DH (2013) Endoscopic bilateral stenting of malignant hilar bile duct obstruction using novel partially covered self-expandable metal stents. Endoscopy 45(Suppl 2):E328–E329

    PubMed  Google Scholar 

  16. Yun JH, Jung GS, Park JG et al (2016) Malignant hilar biliary obstruction: treatment by means of placement of a newly designed Y-shaped branched covered stent. Cardiovasc Intervent Radiol 39:582–590

    Article  Google Scholar 

  17. Inoue T, Okumura F, Naitoh I et al (2016) Feasibility of the placement of a novel 6-mm diameter threaded fully covered self-expandable metal stent for malignant hilar biliary obstructions (with videos). Gastrointest Endosc 84:352–357

    Article  Google Scholar 

  18. Kitamura K, Yamamiya A, Ishii Y, Mitsui Y, Nomoto T, Yoshida H (2017) Side-by-side partially covered self-expandable metal stent placement for malignant hilar biliary obstruction. Endosc Int Open 5:E1211–E1217

    Article  Google Scholar 

  19. Zhu YQ, Edmonds L, Wei LM et al (2017) Technical feasibility and tissue reaction after silicone-covered biodegradable magnesium stent insertion in the oesophagus: a primary study in vitro and in vivo. Eur Radiol 27:2546–2553

    Article  Google Scholar 

  20. Kapoor BS, Mauri G, Lorenz JM (2018) Management of biliary strictures: state-of-the-art review. Radiology 289(3):590–603

    Article  Google Scholar 

Download references

Acknowledgements

This research was supported by Key Scientific Research Projects of Higher Education Institutions in Henan Province (20A320024).

Author information

Author notes

  1. Dechao Jiao and Jing Wang contributed equally to the work.

Authors and Affiliations

  1. Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, China

    Dechao Jiao, Zongming Li, Yanli Wang & Xinwei Han

  2. School of Chemical Engineering and Energy, Zhengzhou University, Zhengzhou, 450052, China

    Jing Wang

  3. Department of Information, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China

    Bingxin Han

Authors
  1. Dechao Jiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bingxin Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zongming Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yanli Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xinwei Han
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xinwei Han.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This prospective study was approved by the institutional review board of the First Affiliated Hospital of Zhengzhou University.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jiao, D., Wang, J., Han, B. et al. Placement of a newly designed partially covered T- or Y-configured self-expanding metallic stent for hilar biliary obstruction: technical note. Radiol med 125, 999–1007 (2020). https://doi.org/10.1007/s11547-020-01196-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-020-01196-w

Keywords

Search

Navigation