Clinical Endoscopy

Prophylactic endoscopic transpapillary gallbladder stenting to prevent acute cholecystitis induced after metallic stent placement for malignant biliary strictures: a retrospective study in Japan: Fumisato Kozakai, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Hidehito Sumiya, Kei Ito; Clin Endosc 2024;57(5):647-655. Published online May 17, 2024; DOI: https://doi.org/10.5946/ce.2023.284

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Background
/Aims: Endoscopic biliary drainage using self-expandable metallic stents (SEMSs) for malignant biliary strictures occasionally induces acute cholecystitis (AC). This study evaluated the efficacy of prophylactic gallbladder stents (GBS) during SEMS placement.
Methods
Among 158 patients who underwent SEMS placement for malignant biliary strictures between January 2018 and March 2023, 30 patients who attempted to undergo prophylactic GBS placement before SEMS placement were included.
Results
Technical success was achieved in 21 cases (70.0%). The mean diameter of the cystic duct was more significant in the successful cases (6.5 mm vs. 3.7 mm, p<0.05). Adverse events occurred for 7 patients (23.3%: acute pancreatitis in 7; non-obstructive cholangitis in 1; perforation of the cystic duct in 1 with an overlap), all of which improved with conservative treatment. No patients developed AC when the GBS placement was successful, whereas 25 of the 128 patients (19.5%) without a prophylactic GBS developed AC during the median follow-up period of 357 days (p=0.043). In the multivariable analysis, GBS placement was a significant factor in preventing AC (hazard ratio, 0.61; 95% confidence interval, 0.37–0.99; p=0.045).
Conclusions
GBS may contribute to the prevention of AC after SEMS placement for malignant biliary strictures.

Citations

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Risk Factors for Cholecystitis After Self-expandable Metallic Stent Placement for Malignant Distal Biliary Obstruction
Hashem Albunni, Azizullah Beran, Nwal Hadaki, Mark A. Gromski, Mohammad Al-Haddad
Journal of Clinical Gastroenterology.2025;[Epub] CrossRef
Risk factors for infection following particle stent placement in obstructive jaundice patients: A retrospective analysis
Gang Wang, Rui Qi
Current Problems in Surgery.2025; 67: 101775. CrossRef
Technical challenges and safety of prophylactic gallbladder stenting with metallic biliary stenting
Masood Muhammad Karim, Om Parkash
Clinical Endoscopy.2024; 57(6): 841. CrossRef

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The Clinical Efficacy of Uisng a Soehendra Stent Retriever for Endoscopic Biliary Drainage in Malignant Biliary Obstruction: Pyo Jun Kim, M.D., Dae Hwan Kang, M.D., Hyung Wook Kim, M.D., Cheol Woong Choi, M.D., Ki Tae Yoon, M.D., Yong Wook Kim, M.D. and Mong Cho, M.D.; Korean J Gastrointest Endosc 2009;39(5):271-275. Published online November 30, 2009

Abstract PDF: Background
/Aims: Endoscopic biliary drainage is widely used for the palliative treatment of malignant biliary obstruction. For the advanced stricture, the general treatments such as a dilating or balloon catheter can not fully expand a duct. The authors used a Soehendra Stent Retriever for these cases, and we evaluated the value of using this instrument for treating these patients.
Methods
From July 2006 to Jun 2008, we studied 12 patients with mailignant biliary obstruction (Klatskin's tumor=10, Gall bladder cancer=2) and who were failed at having a stent inserted with such general treatment such as using a dilating or balloon catheter (M：F=7：5, age=69.1 years old). For the bilateral biliary drainage of the duct, the "stent in stent" method was used and 12 patients were treated with a Soehendra Stent Retriever with clockwise rotation, as well as going forward to expand the target area of the intrahepatic bile duct obstruction and insert a metal stent.
Results
Ten patients among the 12 who were treated by a Soehendra Stent Retriever achieved successful insertion of a stent (technical success, 83.3%), and all 12 patients showed improvement of their jaundice.
Conclusions
To insert bilateral stents for the advanced malignant biliary obstruction, expanding the strictured area with a Soehendra Stent Retriever can improve the success of inserting a stent. (Korean J Gastrointest Endosc 2009; 39:271-275)

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Analysis of Factors Influencing the Long Term Outcome after Endoscopic Stenting for Benign Biliary Stricture: Seok Young Lee, M.D., Hyung Suk Lee, M.D., Won Jae Yoon, M.D., Jun Kyu Lee, M.D., Kwang Hyuck Lee, M.D., Jin-Hyeok Hwang, M.D.*, Ji Bong Jeong, M.D.^†, Ji Kon Ryu, M.D., Yong-Tae Kim, M.D. and Yong Bum Yoon, M.D.; Korean J Gastrointest Endosc 2006;32(1):21-26. Published online January 30, 2006

Abstract PDF: Background
/Aims: The problem with endoscopic management for benign biliary stricture is the occurrence of restenosis after removal of biliary stents. However the factors that influence the rate of restenosis have not yet been identified. The aim of this study was to identify the factors that affect patency of the bile duct after removal of an endoscopic stent for management of benign biliary stricture. Methods: The medical records and potential factors that influence biliary restenosis were analyzed in 19 patients with benign biliary stricture. Results: At the time of stent removal, successful stricture resolution was noted in 13 out of 19 patients. Among these 13 patients, good biliary patency, without restenosis, was observed in 10 patients during a mean follow-up of 24 months. The time interval, from biliary surgery to stricture, tended to be shorter in the group with good results compared to the group with poor results (6.2±3.3 months vs. 80.2±139.3 months respectively: p=0.07). Other factors did not affect the rate of restenosis after removal of the stent. Conclusions: The time interval, from biliary surgery to stricture, tends to influence restenosis after endoscopic management for benign biliary stricture. (Korean J Gastrointest Endosc 2006;32:21⁣26)

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Endoscopic Biliary Drainage Using Soehendra Stent: Joo Ho Lee, M.D., Cheul Woong Choi, M.D., Sang Yong Lee, M.D., Jin Ouk Kang, M.D.,; Korean J Gastrointest Endosc 2003;26(1):15-20. Published online January 30, 2003

Abstract PDF: Background
/Aims: Endoscopic biliary drainage (EBD) has been used effectively as the palliative treatment for malignant biliary obstruction. In high grade strictures, endoscopic stenting can be achieved by dilating devices such as dilating or balloon catheters. Subgroup of malignant biliary obstructions are too stenotic to allow passage of plastic or metal stents. In cases of failure of conventional stenting, we evaluated the efficacy and safety of the 7-Fr Soehendra stent retriever (SSR) used as a dilator. Methods: From January 1999 to September 2001, 14 patients with malignant pancreaticobiliary stirictures (2 pancreatic, 12 biliary) that could not be traversed with plastic or metal stents, underwent stricture dilation with SSR. An endoscopic sphincterotomy was performed and a guide wire was inserted beyond the stricture. Then the SSR was introduced over the guide wire via duodenoscope. Then the stricture was traversed by torquing the SSR clockwise while pushing it. The SSR was removed and then the plastic or metal stents were inserted above the stricture. Results: Of the 14 patients, 13 patients (93%) underwent successful stenting using SSR. Symptom relief was observed in all patients after endoscopic biliary stenting. One patient (7%) went on to percutaneous biliary drainage because we failed to insert the metal stent into the stenotic left hepatic duct after traversing the stricture with SSR. There were no significant complications such as bile duct or duodenal perforation and bleeding. Conclusions: The Soehendra stent retriever is useful and safe for dilation with subsequent stent placement of malignant pancreaticobiliary stirictures resistant to conventional stenting. However, this device may be difficult to pass a tortuous or small-diameter hilar stricture. (Korean J Gastrointest Endosc 2003;26:15⁣20)

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Three Case of Acute Pancreatitis Complicating Endoscopic Insertion of the Biliary Stent: Sung Gwon Kim, M.D., Jong Jae Park, M.D., Moon Gi Chung, M.D., Oh Sang Kwon, M.D.,Dong Kyun Park, M.D., Yang Suh Koo, M.D., Sun Suk Kim, M.D., You Kyung Kim, M.D.,Dong Hoon Kang, M.D., Duck Joo Choi, M.D., Hyun Chul Park, M.D. and Ju Hyun Kim, M.D.; Korean J Gastrointest Endosc 2001;22(4):233-238. Published online April 30, 2001

Abstract PDF: Acute pancreatitis is one of the major complications of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST). Various etiology such as mechanical, chemical, hydrostatic, and thermal factor are thought to be involved for this procedure-related pancreatitis. However, acute pancreatitis can occur as a direct complication of endoscopic biliary drainage (EBD). Although the exact mechanism remains unclear, it is postulated that the stent compresses pancreatic ductal orifice and resultant pancreatic outflow obstruction actually provokes pancreatitis. Using the larger stent diameter over 10 Fr and a straight stent rather than curved one, proximal rather than distal bile duct obstruction are risk factors for stent-induced pancreatitis. We report on three cases of acute pancreatitis complicating the EBD with a plastic stent, nasobiliary catheter, and covered-metallic stent respectively. (Korean J Gastrointest Endosc 2001;22:233⁣238)

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일반적인 내시경적 담도배액법이 어려운 경우에 Soehendra Stent Retriever 을 이용한 담도배액법: Korean J Gastrointest Endosc 2001;23(5):326-326. Published online November 30, 2000

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증례 : 담도 췌장 ; 간절제술 후 발생한 기관지 담도 누공 1예 ( Case Reports : Biliary Tract & Pancreas ; Bronchobiliary Fistula Secondary to Hepatic Resection - Treatment by endoscopic retrograde biliary drainage - ): Korean J Gastrointest Endosc 1997;17(2):220-225. Published online November 30, 1996

Abstract PDF: Bronchobiliary fistula (BBF) is a rare disorder, defined as opening of a passage between the bronchial tree and the biliary tract and presence of bile in the sputum (biloptysis). BBF usually occurs either in the congenital form or following multiple causes, including mainly thoracoabdominal trauma, liver abscess, parasitic liver disease, choledocholithiasis, and post operative biliary stenosis. The cardinal clinical features were respiratory symptoms, jaundice, and cholangitis. Management of fistula is often very difficult and can be associated with high morbidity and mortality rates. Early recognition and proper management are essential to avoid a fatal outcome. To date, surgery has been favored as the most efficient therapeutic option, although percutmeous approaches, and more recently, endoscopic sphincterotomy and stent insertion, have succeeded in resolving certain kind of BBF. We are reporting a case of BBF secondary to hepatic resection of hepatocelluar carcinoma which was managed by endoscopic retrograde biliary stenting for keeping optimal bile drainage and surgical operation for resection of recurred tumor and removal of subphrenic abscess, (Korean J Gastrointest Endosc 17: 220-224, 1997)

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원저 : 악성 폐쇄성 황달환자에서 코일 ( coli ) 형 금속배액관 삽관술 ( Original Articles : Metallic EndoCoilTM Stent Application for Patients with Malignant Obstructive Jaundice ): Korean J Gastrointest Endosc 1995;15(1):54-62. Published online November 30, 1994

Abstract PDF: We report our experience in five patients with malignant obstructive jaundice with a new self expandable metallic stent, a coil spring made from nickel-titanium alloy. Endoscopic biliary drainage(EBD) is a safe and effective noninvasive biliary drainage method and is indicated with malignant obstructive jaundice. In order to avoid being limited by the size of the instrumentation channel of the endoscope, expandable stents have been developed. The main problems with these expandable metal stents are tumor ingrowth leading to reobstruction, migration of the stent from its original position, and epithelial trauma by the distal hard edges of the stent. The new super-elastic metallic coil stent which has a very strong radial force (EndoCoil'" stent, Instent Co.) was developed to solve the above mentioned problems. The stent which is constricted over an introducing catheter is inserted by transduodenal approach. It expands spontaneously after release to its original 8 mm diameter. During the last 6.5 rnonths, 5 stents were inserted in patients with cholangiocarcinoma, pancreatic carcinoma and cancer of the ampulla of Vater to releave jaundice. Clinical improvement was achieved in all the patients except in one who died from multiple organ metastasis. After a mean follow-up of 6 month., patients had no evidence of biliary reobstruction. Although follow-up is short, these results are encouraging, and this new metallic stent seems to have several advantages over the current commercially available ones.

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내시경적 담도배액법 ( EBD ) 후 발생한 십이지장 천공 1예 ( A Case of Duodenal Perforation following Endoscopic Biliary Drainage ( EBD ) ): Korean J Gastrointest Endosc 1992;12(1):91-97. Published online November 30, 1991

Abstract PDF: Placement of an endoprosthesis for palliative decompression of biliary obstruction has been advocated as an effective alternative for interanl-external drainage catheters, of which the care and psychological impact of the external segment protruded through the skin has been a difficult problem. (continue...)

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