Endoscopic Bilateral Metallic Stenting for Malignant Hilar Obstruction Using Newly Designed Y Stent: Case Report

Palliative treatment of malignant hilar biliary obstruction (MHBO) is difficult. To circumvent this problem, a “Y-stent” has been designed which consists of two uncovered self−expanding metallic stents (SEMS): the first SEMS has a radiologically marked segment with wider mesh holes in its middle part, through which the second stent is delivered on the other side. We report three cases of MHBO, which were palliatively treated using this biliary Y-stent. From 2011 to 2012, three consecutive patients with unresectable MHBO of Bismuth type III or greater underwent placement of Y-Stent. Before Y-Stent placement, all the patients underwent endoscopic bilateral biliary drainage using two plastic stents. Technical success was achieved for all 3 patients. Stent occlusion did not occur up to date (more than a period of 220 days) except in one who died from heart failure. In conclusion the Y-stent appears to effective and safe for the management of MHBO.

[1]  N. Sasahira,et al.  Newly designed large cell Niti-S stent for malignant hilar biliary obstruction: a pilot study , 2011, Surgical Endoscopy.

[2]  Hyun Jong Choi,et al.  Newly designed stent for endoscopic bilateral stent-in-stent placement of metallic stents in patients with malignant hilar biliary strictures: multicenter prospective feasibility study (with videos). , 2009, Gastrointestinal endoscopy.

[3]  Tae Oh Kim,et al.  Endoscopic bilateral metal stent placement for advanced hilar cholangiocarcinoma: a pilot study of a newly designed Y stent. , 2007, Gastrointestinal endoscopy.

[4]  Suk Kim,et al.  T-configured dual stent placement in malignant biliary hilar duct obstructions with a newly designed stent. , 2004, Journal of vascular and interventional radiology : JVIR.

[5]  M. Persico,et al.  Unilateral placement of metallic stents for malignant hilar obstruction: a prospective study. , 2003, Gastrointestinal endoscopy.

[6]  J. Bergman,et al.  Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: efficacy of self-expandable metallic Wallstents. , 2002, Gastrointestinal endoscopy.

[7]  G. D. De Palma,et al.  Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: results of a prospective, randomized, and controlled study. , 2001, Gastrointestinal endoscopy.

[8]  S. Sherman.  Endoscopic drainage of malignant hilar obstruction: is one biliary stent enough or should we work to place two? , 2001, Gastrointestinal endoscopy.

[9]  F. Caroli-Bosc,et al.  Endoscopic bilateral metal stent placement for malignant hilar stenoses: identification of optimal technique. , 2000, Gastrointestinal endoscopy.

[10]  P. Kortan,et al.  Outcome in patients with bifurcation tumors who undergo unilateral versus bilateral hepatic duct drainage. , 1996, Gastrointestinal endoscopy.

[11]  P. Cotton,et al.  Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion. , 1991, Gut.

[12]  P. Cotton,et al.  A comparison of right versus left hepatic duct endoprosthesis insertion in malignant hilar biliary obstruction. , 1989, Endoscopy.

[13]  J. Devière,et al.  Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage. , 1988, Gastrointestinal endoscopy.

[14]  W. Silverman,et al.  New technique for bilateral metal mesh stent insertion to treat hilar cholangiocarcinoma. , 1996, Gastrointestinal endoscopy.