Clinical Endoscopy

Original Articles

Endoscopic ultrasound-guided hepaticogastrostomy and endoscopic retrograde cholangiopancreatography-guided biliary drainage for distal malignant biliary obstruction due to pancreatic cancer with asymptomatic duodenal invasion: a retrospective, single-center study in Japan: Naminatsu Takahara, Yousuke Nakai, Kensaku Noguchi, Tatsunori Suzuki, Tatsuya Sato, Ryunosuke Hakuta, Kazunaga Ishigaki, Tomotaka Saito, Tsuyoshi Hamada, Mitsuhiro Fujishiro; Received February 14, 2024 Accepted May 13, 2024 Published online August 23, 2024; DOI: https://doi.org/10.5946/ce.2024.031 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Duodenal invasion (DI) is a risk factor for early recurrent biliary obstruction (RBO) in endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) may reduce early RBO in cases of asymptomatic DI, even when ERCP is possible.
Methods
We enrolled 56 patients with pancreatic cancer and asymptomatic DI who underwent EUS-HGS (n=25) or ERCP-BD (n=31). Technical and clinical success, early (<3 months) and overall RBO rates, time to RBO (TRBO), and adverse events (AEs) were compared between the EUS-HGS and ERCP-BD groups. Risk factors for early RBO were also evaluated.
Results
Baseline characteristics were similar between the groups. Both procedures demonstrated 100% technical and clinical success rates, with a similar incidence of AE (48% vs. 39%, p=0.59). While the median TRBO was comparable (5.7 vs. 8.8 months, p=0.60), EUS-HGS was associated with a lower incidence of early RBO compared to ERCP-BD (8% vs. 29%, p=0.09). The major causes of early RBO in ERCP-BD were sludge and food impaction, rarely occurring in EUS-HGS. EUS-HGS was potentially reduced early RBO (odds ratio, 0.32; p=0.07).
Conclusions
EUS-HGS can be a viable option for treating pancreatic cancer with asymptomatic DI.

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Hepatobiliary scintigraphy of bile excretion after endoscopic ultrasound-guided hepaticogastrostomy for malignant biliary obstruction: a retrospective study in Japan: Masanori Yamada, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Toshitaka Fukui; Clin Endosc 2024;57(6):798-806. Published online August 20, 2024; DOI: https://doi.org/10.5946/ce.2023.291

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Hepatobiliary scintigraphy (HBS) is used to evaluate bile excretion. This study aimed to evaluate biliary excretion during endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using HBS.
Methods
We retrospectively evaluated 78 consecutive patients with malignant extrahepatic biliary obstruction, who underwent HBS after EUS-HGS between April 2015 and July 2022. The peak time and decay rate were scored with 0, 1, or 2 points based on thresholds of 20 and 35 minutes, and 10% and 50%, respectively. A total score of 4 or 3 was considered indicative of good bile excretion, whereas scores of 2, 1, or 0 indicated poor bile excretion.
Results
The good and poor bile excretion groups included 40 and 38 cases, respectively. The group with good bile excretion had a significantly longer time to recurrent biliary obstruction compared to the poor bile excretion group (not reached vs. 124 days, p=0.026). Multivariate analysis identified the site of obstruction as a significant factor influencing good bile excretion (odds ratio, 3.39; 95% confidence interval, 1.01–11.4, p=0.049), with superior bile excretion observed in cases involving upper biliary obstruction compared to middle or lower biliary obstruction.
Conclusions
In patients with malignant biliary obstruction who underwent HGS, the site of obstruction is significantly associated with stent patency.

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Potential of 6-mm-diameter fully covered self-expandable metal stents for unresectable malignant distal biliary obstruction: a propensity score-matched study: Daiki Yamashige, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Soma Fukuda, Shin Yagi, Kohei Okamoto, Hidenobu Hara, Yuya Hagiwara, Daiki Agarie, Tetsuro Takasaki, Akihiro Ohba, Shunsuke Kondo, Chigusa Morizane, Hideki Ueno, Miyuki Sone, Yutaka Saito, Takuji Okusaka; Received February 23, 2024 Accepted April 2, 2024 Published online July 29, 2024; DOI: https://doi.org/10.5946/ce.2024.044 [Epub ahead of print]

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: To date, only thinner-diameter metal stents have been evaluated for unresectable malignant distal biliary obstruction (UR-MDBO). This study investigated the outcomes and optimal cohorts for a 6-mm-diameter fully covered self-expandable metal stent (FCSEMS) compared with those for a 10-mm-diameter FCSEMS.
Methods
This single-center retrospective cohort study included patients who underwent initial transpapillary metal stenting for UR-MDBO. Propensity score matching (1:1) analysis was performed.
Results
Of 133/68 patients who underwent 6-mm/10-mm-diameter FCSEMS deployment, 59 in each group were selected. The median time to recurrent biliary obstruction was not significantly different between the groups (p=0.46). In contrast, use of the 6-mm-diameter FCSEMS resulted in a significantly reduced incidence of stent-related adverse events (AEs) (p=0.016), especially cholecystitis (p=0.032), and patients aged <70 years were particularly affected by this significant reduction. Among the patients in the end-stage cohort who were unable to continue chemotherapy after FCSEMS deployment, the free rate of stent-related events, including recurrent biliary obstruction and stent-related AEs, was significantly higher in the 6-mm group (p=0.027).
Conclusions
For UR-MDBO, a 6-mm-diameter FCSEMS can be an optimal and safe option in the younger cohort with a relatively high risk of AEs and in the end-stage cohort requiring safer drainage without interference from stent-related events during times of poor prognosis.

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Survival Benefit of Intraductal Radiofrequency Ablation for Malignant Biliary Obstruction: A Systematic Review with Meta-Analysis: Byung Hyo Cha, Myoung-Jin Jang, Sang Hyub Lee; Clin Endosc 2021;54(1):100-106. Published online January 15, 2021; DOI: https://doi.org/10.5946/ce.2020.254

Abstract PDF PubReader ePub

Background
/Aims: Cholangiocarcinoma (CCA) is a rare but aggressive disease with a poor survival. Recent trials have shown improved survival with intraductal radiofrequency ablation (RFA) therapy. We performed a systematic review with meta-analysis to determine the survival benefit of endoscopic RFA for unresectable extrahepatic CCA with malignant biliary obstruction (MBO).
Methods
A systematic search from 1970 to 2020 was performed in MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials. gov. We selected eligible studies reporting relative risks, hazard ratios (HRs), or odds ratios, adjusted by controlling for confounding factors of survival rate and stent patency duration, among patients with extrahepatic CCA with MBO treated with RFA with stent insertion or stent insertion only.
Results
A total of eight trials (three randomized and five nonrandomized) with a total of 420 patients were included in the metaanalysis. Pooled overall survival analysis favored RFA treatment with stent insertion (HR, 0.47; 95% confidence interval [CI], 0.34– 0.64; I²=47%; p=0.09); however, no significant difference was found in the duration of stent patency between the groups (HR, 0.79; 95% CI, 0.57–1.09; I²=7%; p=0.36).
Conclusions
RFA therapy with stent insertion may confer a survival benefit compared with stent insertion only in patients with CCA and MBO.

Citations

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Matheus de Oliveira Veras, Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Guilherme Henrique Peixoto de Oliveira, Rômulo Sérgio Araújo Gomes, Davi Lucena Landim, Felipe Giacobo Nunes, Tomazo Antônio Prince Franzini, Marcos Eduardo Lera dos Santos, W
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Reply to Chandrasekhara and Aggarwal
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Il Sang Shin, Jong Ho Moon, Yun Nah Lee, Jun Ho Myeong, Tae Hoon Lee, Jae Kook Yang, Young Deok Cho, Sang-Heum Park
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Feasibility and safety of trans-biliary cryoablation: Preclinical evaluation of a novel flexible cryoprobe
Chao Zhang, Linzhong Zhu, Shousheng Tang, Jukun Wang, Yu Li, Xin Chen, Chunjing Bian, Dongbin Liu, Guokun Ao, Tao Luo
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Hayat Khizar, Yufei Hu, Yanhua Wu, Kamran Ali, Junaid Iqbal, Muhammad Zulqarnain, Jianfeng Yang
Journal of Clinical Gastroenterology.2023; 57(4): 335. CrossRef
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In-stent radiofrequency ablation with uncovered metal stent placement for tumor ingrowth/overgrowth causing self-expandable metal stent occlusion in distal malignant biliary obstruction: multicenter propensity score–matched study
Namyoung Park, Min Kyu Jung, Eui Joo Kim, Woo Hyun Paik, Jae Hee Cho
Gastrointestinal Endoscopy.2023; 97(4): 694. CrossRef
ACG Clinical Guideline: Diagnosis and Management of Biliary Strictures
B. Joseph Elmunzer, Jennifer L. Maranki, Victoria Gómez, Anna Tavakkoli, Bryan G. Sauer, Berkeley N. Limketkai, Emily A. Brennan, Elaine M. Attridge, Tara J. Brigham, Andrew Y. Wang
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Zahid Ijaz Tarar, Umer Farooq, Mustafa Gandhi, Ghulam Ghous, Saad Saleem, Faisal Kamal, Zaid Imam, Laith Jamil
European Journal of Gastroenterology & Hepatology.2023; 35(6): 646. CrossRef
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Endoluminal radiofrequency ablation in patients with malignant biliary obstruction: a randomised trial
Jana Jarosova, Lea Zarivnijova, Ivana Cibulkova, Jan Mares, Peter Macinga, Alzbeta Hujova, Premysl Falt, Ondrej Urban, Jan Hajer, Julius Spicak, Tomas Hucl
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Chenming Liu, Jiaming Dong, Yuxing Liu, Siyuan Zhang, Ruanchang Chen, Haijun Tang
Journal of International Medical Research.2023;[Epub] CrossRef
Intraductal Therapies for Cholangiocarcinoma
Abhishek Agnihotri, David E. Loren
Techniques and Innovations in Gastrointestinal Endoscopy.2022; 24(2): 200. CrossRef
Silver Nanofunctionalized Stent after Radiofrequency Ablation Suppresses Tissue Hyperplasia and Bacterial Growth
Yubeen Park, Dong-Sung Won, Ga-Hyun Bae, Dae Sung Ryu, Jeon Min Kang, Ji Won Kim, Song Hee Kim, Chu Hui Zeng, Wooram Park, Sang Soo Lee, Jung-Hoon Park
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David M. de Jong, Jeska A. Fritzsche, Amber S. Audhoe, Suzanne S. L. Yi, Marco J. Bruno, Rogier P. Voermans, Lydi M. J. W. van Driel
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Nadia V. Guardado, Kaysey Llorente, Benoit Blondeau
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Cholecystitis after Placement of Covered Self-Expandable Metallic Stents in Patients with Distal Malignant Biliary Obstructions: Masafumi Watanabe, Kosuke Okuwaki, Jun Woo, Mitsuhiro Kida, Hiroshi Imaizumi, Tomohisa Iwai, Hiroshi Yamauchi, Toru Kaneko, Rikiya Hasegawa, Takahiro Kurosu, Naoki Minato, Hiroki Haradome, Wasaburo Koizumi; Clin Endosc 2021;54(4):589-595. Published online November 17, 2020; DOI: https://doi.org/10.5946/ce.2020.136

Abstract PDF PubReader ePub

Background
/Aims: Cholecystitis can occur after the placement of covered self-expandable metallic stents for distal malignant biliary obstructions. We aimed to identify risk factors for cholecystitis following covered self-expandable metallic stent placement.
Methods
We investigated risk factors related to cholecystitis following covered self-expandable metallic stent placement in 118 patients with distal malignant biliary obstructions between January 1, 2015 and April 30, 2019. Endoscopic assessments and tumor invasion to the arteries feeding the gallbladder were determined by a pancreaticobiliary endoscopist and a radiologist, respectively.
Results
The median patient age was 72 years (men, 61.0%). The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct were observed in 35 (29.7%) and 35 (29.7%) patients, respectively. During the observation period (median, 179 days), cholecystitis occurred in 18 (15.3%) patients. Multivariate analysis revealed the flow of the contrast agent into the gallbladder (p=0.023) and tumor involvement in the orifice of the cystic duct (p=0.005) as significant independent risk factors associated with cholecystitis.
Conclusions
The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct are potential independent risk factors for cholecystitis following the placement of covered self-expandable metallic stents. A follow-up prospective study is warranted to validate their influence.

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Adverse events of self-expandable metal stent placement for malignant distal biliary obstruction: a large multicenter study
Takashi Tamura, Takuo Yamai, Norimitsu Uza, Tomoaki Yamasaki, Atsuhiro Masuda, Fumimasa Tomooka, Hirotsugu Maruyama, Minoru Shigekawa, Takeshi Ogura, Katsutoshi Kuriyama, Masanori Asada, Hisakazu Matsumoto, Mamoru Takenaka, Koichiro Mandai, Yui Osaki, Ken
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Fully covered versus partially covered self-expandable metal stents for palliation of distal malignant biliary obstruction: a systematic review and meta-analysis
Giuseppe Vanella, Chiara Coluccio, Alessandro Cucchetti, Roberto Leone, Giuseppe Dell’Anna, Paolo Giuffrida, Carmela Abbatiello, Cecilia Binda, Carlo Fabbri, Paolo Giorgio Arcidiacono
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Harishankar Gopakumar, Ritu Raj Singh, Vakya Revanur, Rajanikanth Kandula, Srinivas R. Puli
American Journal of Gastroenterology.2024; 119(8): 1607. CrossRef
Cholecystitis in patients with a fully covered self-expandable metal stent with and without externally anchored plastic stents
José Miguel Jiménez-Gutiérrez, Félix Téllez-Avila
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Risk factors and treatment strategies for cholecystitis after metallic stent placement for malignant biliary obstruction: a multicenter retrospective study
Akihiro Matsumi, Hironari Kato, Taiji Ogawa, Toru Ueki, Masaki Wato, Masakuni Fujii, Tatsuya Toyokawa, Ryo Harada, Yuki Ishihara, Masahiro Takatani, Hirofumi Tsugeno, Naoko Yunoki, Takeshi Tomoda, Toshiharu Mitsuhashi, Motoyuki Otsuka
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Incidence of Cholecystitis After Endoscopic Biliary Drainage Using a Low Axial Force Covered Self‐Expandable Metallic Stent in Patients With Malignant Distal Biliary Obstruction: A Multicenter Prospective Study
Naoki Minato, Kosuke Okuwaki, Masafumi Watanabe, Jun Woo, Takaaki Matsumoto, Masayoshi Tadehara, Toru Kaneko, Junro Ishizaki, Tomohisa Iwai, Hiroshi Imaizumi, Mitsuhiro Kida, Hiroki Haradome, Chika Kusano
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Se Woo Park, Kyong Joo Lee, Moon Jae Chung, Jung Hyun Jo, Hee Seung Lee, Jeong Youp Park, Seung Woo Park, Si Young Song, Huapyong Kang, Eui Joo Kim, Yeon Suk Kim, Jae Hee Cho, Seungmin Bang
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Risk factors for early and late cholecystitis after covered metal stent placement for distal biliary obstruction
Tatsuya Ishii, Tsuyoshi Hayashi, Hajime Yamazaki, Risa Nakamura, Kosuke Iwano, Ryo Ando, Haruka Toyonaga, Toshifumi Kin, Kuniyuki Takahashi, Akio Katanuma
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Efficacy and complications of inoperable malignant distal biliary obstruction treatment by metallic stents: fully covered or uncovered?
Jiangning Gu, Xiaoyi Guo, Yong Sun, Bin Fan, Haoran Li, Ting Luo, Haifeng Luo, Jiao Liu, Feng Gao, Yuan Gao, Guang Tan, Xiaoming Liu, Zhuo Yang
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Endoscopic Management of Pancreatobiliary Malignancies
Dong Wook Lee, Eun Young Kim
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A Comparative Study on the Efficacy of Covered Metal Stent and Plastic Stent in Unresectable Malignant Biliary Obstruction: Jae Myoung Choi, Jin Hong Kim, Soon Sun Kim, Jun Hwan Yu, Jae Chul Hwang, Byung Moo Yoo, Sang Heum Park, Ho Gak Kim, Dong Ki Lee, Kang Hyun Ko, Kyo Sang Yoo, Do Hyun Park; Clin Endosc 2012;45(1):78-83. Published online March 31, 2012; DOI: https://doi.org/10.5946/ce.2012.45.1.78

Abstract PDF PubReader ePub

Background/Aims

The placement of self expandable metal stent (SEMS) is one of the palliative therapeutic options for patients with unresectable malignant biliary obstruction. The aim of this study was to compare the effectiveness of a covered SEMS versus the conventional plastic stent.

Methods

We retrospectively evaluated 44 patients with unresectable malignant biliary obstruction who were treated with a covered SEMS (21 patients) or a plastic stent (10 Fr, 23 patients). We analyzed the technical success rate, functional success rate, early complications, late complications, stent patency and survival rate.

Results

There was one case in the covered SEMS group that had failed technically, but was corrected successfully using lasso. Functional success rates were 90.5% in the covered SEMS group and 91.3% in the plastic stent group. There was no difference in early complications between the two groups. Median patency of the stent was significantly prolonged in patients who had a covered SEMS (233.6 days) compared with those who had a plastic stent (94.6 days) (p=0.006). During the follow-up period, stent occlusion occurred in 11 patients of the covered SEMS group. Mean survival showed no significant difference between the two groups (covered SEMS group, 236.9 days; plastic stent group, 222.3 days; p=0.182).

Conclusions

The patency of the covered SEMS was longer than that of the plastic stent and the lasso of the covered SEMS was available for repositioning of the stent.

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Outcomes of Self-expandable Metal Stents in Patients With Unresectable Gallbladder Cancer Undergoing Percutaneous Biliary Drainage
Pavithra Subramanian, Mukul Morya, Pankaj Gupta, Ruby Siddiqui, Anupam Singh, Vaneet Jearth, Jimil Shah, Santosh Irrinki, Jayanta Samanta, Harshal Mandavdhare, Vishal Sharma, Harjeet Singh, Saroj K. Sinha, Thakur D. Yadav, Vikas Gupta, Lileswar Kaman, Gau
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Effectiveness, safety, and factors associated with the clinical success of endoscopic biliary drainage for patients with hepatocellular carcinoma: a retrospective multicenter study
Akihiro Matsumi, Hironari Kato, Toru Ueki, Etsuji Ishida, Masahiro Takatani, Masakuni Fujii, Masaki Wato, Tatsuya Toyokawa, Ryo Harada, Hirofumi Tsugeno, Minoru Matsubara, Hiroshi Matsushita, Hiroyuki Okada
BMC Gastroenterology.2021;[Epub] CrossRef
Malignant obstructive jaundice: approaches to minimally invasive biliary decompression
B. L. Duberman, D. V. Mizgirev, A. M. Epshtein, V. N. Pozdeev, A. V. Tarabukin
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Prognostic value of inflammation-based markers in patients with recurrent malignant obstructive jaundice treated by reimplantation of biliary metal stents
Hao Jin, Qing Pang, Huichun Liu, Zongkuang Li, Yong Wang, Yimin Lu, Lei Zhou, Hongtao Pan, Wei Huang
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Agnieszka Budzyńska, Ewa Nowakowska-Duława, Tomasz Marek, Marek Hartleb
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Linda Ann Hou, Jacques Van Dam
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Takao Itoi, Atsushi Sofuni, Fumihide Itokawa, Ryosuke Tonozuka, Kentaro Ishii
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Review

Endoscopic Stent Placement in the Palliation of Malignant Biliary Obstruction: Jin Hong Kim; Clin Endosc 2011;44(2):76-86. Published online December 31, 2011; DOI: https://doi.org/10.5946/ce.2011.44.2.76

Abstract PDF PubReader ePub

Biliary drainage with biliary stent placement is the treatment of choice for palliation in patients with malignant biliary obstruction caused by unresectable neoplasms. In such patients, the endoscopic approach can be initially used with percutaneous radiological intervention. In patients with unresectable malignant distal bile duct obstructions, endoscopic biliary drainage with biliary stent placement has now become the main and least invasive palliative modality, which has been proven to be more effective in >80% of cases with lower morbidity than surgery, and perhaps may provide a survival benefit. In patients with unresectable malignant hilar obstruction, the endoscopic approach for biliary drainage with biliary stent placement has also been considered as the treatment of choice. There is still a lack of clear consensus on the use of covered versus uncovered metal stents in malignant distal bile duct obstructions and plastic versus metal stents and unilateral versus bilateral drainage in malignant hilar obstructions.

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Development of novel biliary metal stent with coil-spring structure and its application in vivo swine biliary stricture model
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Role of radiofrequency ablation in advanced malignant hilar biliary obstruction
Mamoru Takenaka, Tae Hoon Lee
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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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A Comparative Study on the Efficacy of Covered Metal Stent and Plastic Stent in Malignant Biliary Obstruction: Jun Hwan Kim, M.D., Byung Ik Jang, M.D., Tae Nyeun Kim, M.D. and Moon Kwan Chung, M.D.; Korean J Gastrointest Endosc 2003;27(2):64-69. Published online August 30, 2003

Abstract PDF: Background
/Aims: Insertion of self-expanding metallic stents (SEMS) has become an established option for the palliation of malignant biliary obstruction (MBO). However, stent occlusion by tumor ingrowth is still an unsolved problem. To overcome this problem, membrane-covered SEMSs have been developed. The purpose of this study was to compare the effectiveness of membrane-covered SEMS versus plastic stent in the treatment of MBO. Methods: Between Jan 2001 and Jul 2002, 57 patients with unresectable MBO who initially had plastic stents inserted were randomized to receive either plastic stent and membrane-covered SEMSs after initial plastic stent failure. Results: Placement of either plastic stents or membrane- covered SEMs was successful in all patients. Mean patency duration of stents were significantly longer in membrane- covered SEMS group (189 days) than in plastic stent group (82 days) (p=0.01). The causes of stent failure were occlusion in 10 cases and migration in 1 case in membrane- covered SEMS group. Of these occluded 10 cases, tumor ingrowth was noted in 7, tumor overgrowth in 2, and biliary incrustation in 1. Conclusions: Membrane-covered SEMS has a longer patency than plastic stent. However, new membrane covering material is needed to prevent tumor ingrowth more effectively. (Korean J Gastrointest Endosc 2003;27:64⁣69)

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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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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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금속제 스텐트의 개통성에 영향을 미치는 악성 담도 폐쇄의 특징 ( Features of Malignant Biliary Obstruction Affecting the Patency of Metallic Stents : A Multicenter Study ): Korean J Gastrointest Endosc 2001;23(2):100-108. Published online November 30, 2000

Abstract PDF: Background
/Aims: Although metalic stents are established therapeutic options for the palliation of malignant biliary obstruction, it remains unclear which stricture or stent related factors affect the stent patency. Methods: Metallic Wallstents (Microvasive, Boston-Scientific, MA, U.S.A.) were inserted endoscopically in 68 patients (mean age; 70.2+8.5, M: F=38: 30) with malignant biliary obstruction. Patency rates were prospectively analyzed ac- cording to the characteristics of malignant strictures in cluding length, morphologic type and degree of stricture. Furthermore, patient age, initial serum bilirubin level, the length of stent, the adequate expansion time, and the location of the distal stent end were evaluated as possible factors affecting the stent patency. Stent patency was assessed using the survival analysis of the Kaplan-Meier estimation and Cox regression analysis. Results: Median overall stent patency was 231 days and overall rate of stent occlusion was 41,2% (28/68). The causes of stent blockage were tumoral ingrowth in 23 patients (33.8%), distal overgrowth of the cancer in 3 (4.4%), proximal overgrowth in 1 (1.5%) and sludge incrustation in 1 patient (1,5%). No significant differences in metallic stent patency rates according to primary tumor type, length and morphologic type of stricture, and length and location of distal end of the stent were found. Log-rank test and multivariate regression analysis, however, demonstrated that the degree of stricture assessed by cannula or guidewire passage and the adequate expansion time of the stent are independent factors associated with long-term metallic stent patency. Conclusions: Our study showed that early expansibility of the stent and easy passage of larger-caliber instruments over the stricture were favorable factors for long-term patency of the metallic stent. (Korean J Gastrointest Endosc 2001;23:100-108)

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악성 담관협착에서 Niti - S 스텐트 및 Wallstent 의 비교 ( A New Covered Biliary Metal Stent versus Uncovered Wallstent for Malignant Biliary Obstruction ): Korean J Gastrointest Endosc 2001;23(2):93-99. Published online November 30, 2000

Abstract PDF: Background
/Aims: In order to provide a complete ob- stacle to tumoral growth, we designed a new self- expandible metal stent fully covered with polyurethane membrane. The purpose cf the study was to compare the safety and effectiveness of a new membrane-covered Niti-S stent versus conventional uncovered Wallstent. Methods: In a prospective trial, 59 patients with malignant extrahepatic biliary obstruction received either a newly developed covered metal stent (Niti-S stent, 30 cases) or an uncovered metal stent (Wallstent, 29 cases) by the endoscopic trans-papillary route. Results: Effective biliary decompression was achieved in all patients initially, and short-term results were similar in both groups. Stent failure was observed in 4 of the 30 patients (13%) after a median period of 165 days in the Niti-S group and in 8 of the 29 patients (28%) after a median period of 152 days in the Wallstent group. The reasons of stent failure were occlusion (n=3) and migration (n=l) in the covered Niti-S stent group and occlusion (n=8) in uncovered Wallstent group. According to the Kaplan-Meier life table analysis, the patency rates after 90, 180, and 360 days were 100%, 90%, and 74% in covered Niti-S stent group and 100%, 73%, and 61% in uncovered Wallstent group respectively. The occluded membrane-covered Niti-S stent was easily removed endoscopically and a new Niti-S stent was reinserted in one patient. Conclusions: The new, membrane-covered Niti-S stent has a lower stent failure rate and a tendency toward long-term patency rate compared to uncovered Wallstent. The covering may effectively prevent tumor ingrowth and it is sometimes possible to remove an occluded Niti-S stent. (Korean J Gastrointest Endosc 2001;23:93-99)

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