Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction
Article first published online: 12 FEB 2009
© 2009 The Authors. Journal compilation © 2009 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 24, Issue 4, pages 552–557, April 2009
How to Cite
Naitoh, I., Ohara, H., Nakazawa, T., Ando, T., Hayashi, K., Okumura, F., Okayama, Y., Sano, H., Kitajima, Y., Hirai, M., Ban, T., Miyabe, K., Ueno, K., Yamashita, H. and Joh, T. (2009), Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction. Journal of Gastroenterology and Hepatology, 24: 552–557. doi: 10.1111/j.1440-1746.2008.05750.x
- Issue published online: 30 MAR 2009
- Article first published online: 12 FEB 2009
- Accepted for publication 29 October 2008.
- bilateral drainage;
- endoscopic biliary drainage;
- malignant hilar biliary obstruction;
- self-expanding metal stent;
- unilateral drainage
Background and Aim: The extent of liver drainage for palliative treatment of malignant hilar biliary obstruction is controversial. The aim of this study was to compare endoscopic unilateral versus bilateral drainage in patients with malignant hilar biliary obstruction using a self-expanding metal stent (SEMS).
Methods: We carried out a retrospective review of 46 consecutive patients with malignant hilar biliary obstruction who were treated by endoscopic biliary drainage using SEMS between 1997 and 2005. Unilateral metal stenting (group A) was performed in 17 patients between 1997 and 2000, and bilateral metal stenting (group B) was performed in 29 patients between 2001 and 2005. The successful stent insertion, successful drainage, early complications, late complications, stent patency, and survival rate for groups A and B were evaluated and compared retrospectively.
Results: There were no significant differences between the two groups in successful stent insertion (100% vs 90%, group A vs B, respectively), successful drainage (100% vs 96%), early complications (0% vs 10%), or late complications (65% vs 54%). Cumulative stent patency was significantly better in group B than in group A (P = 0.009). In cases of cholangiocarcinoma, cumulative stent patency was significantly better in group B than in group A (P = 0.009), whereas there were no inter-group differences for gallbladder carcinoma. Cumulative survival did not differ significantly between the groups.
Conclusions: Endoscopic bilateral drainage using SEMS for malignant hilar biliary obstruction is more effective than unilateral drainage in terms of cumulative stent patency, especially in cases of cholangiocarcinoma.