Fishing Line Assisted Endoscopic Placement of Multiple Plastic Biliary Stents for Unresectable Malignant Hilar Biliary Obstruction: a Retrospective Study

Overview

Journal BMC Gastroenterol

Publisher Biomed Central

Specialty Gastroenterology

Date 2021 Nov 20

PMID 34798836

Citations 1

Authors

Huahui Zhang

Fengdong Li

Jian Huang

Chunyan Huo

Jin Huang

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Stent migration is one of the most common complications during the placement of multiple plastic biliary stents (MPBS) under endoscopy. This study aims to evaluate the feasibility and efficiency of the fishing line assisted (FLA) method for preventing the complication.

Methods: Patients with unresectable malignant hilar biliary obstruction (MHBO) who undergone endoscopic placement of MPBS using the FLA or conventional method from May 2018 to April 2021 in our center were enrolled in the study. The endpoints of this study were the stent migration rate, technical success rates, adverse events rates, times of stent migration, and the procedure time.

Results: FLA group (N = 19) and conventional group (N = 22) had similar baseline characteristics of the patients. The technical success rates (100% vs. 95.5%; P > 0.05), ERCP-related adverse events rates (5.3% vs. 4.5%; P > 0.05), and the stent-related adverse events rates (0% vs. 4.5%; P > 0.05) were no significant differences between the FLA and conventional groups. MPBS inserted using the conventional method consumed more time (median, 33.9 min vs. 15.6 min; P < 0.05) method and increased the times of stent migration (median, 3 times vs. 0 times; P < 0.05) than using the FLA method. Even if no statistical difference was detected in the stent migration rate between groups, this rate was lower in the FLA group than the conventional group (0% vs. 13.6%; P > 0.05).

Conclusions: FLA method is an effective technique for MPBS implantation to prevent stent migration during endoscopic retrograde cholangiography (ERCP). The method should be applied to patients with unresectable MHBO who need to place MPBS.

Citing Articles

Different percutaneous transhepatic biliary stent placements and catheter drainage in the treatment of middle and low malignant biliary obstruction.

Yang Y, Yan Z, Jiao Y, Yang W, Cui Q, Chen S World J Gastrointest Surg. 2023; 15(7):1397-1404.

PMID: 37555122 PMC: 10405108. DOI: 10.4240/wjgs.v15.i7.1397.

References

Cheon Y, Oh H, Cho Y, Lee T, Shim C . New 10F soft and pliable polyurethane stents decrease the migration rate compared with conventional 10F polyethylene stents in hilar biliary obstruction: results of a pilot study. Gastrointest Endosc. 2012; 75(4):790-7. DOI: 10.1016/j.gie.2011.11.010. View

Iwasaki A, Kubota K, Kurita Y, Hasegawa S, Fujita Y, Kagawa K . The placement of multiple plastic stents still has important roles in candidates for chemotherapy for unresectable perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci. 2020; 27(10):700-711. DOI: 10.1002/jhbp.804. View

Song T, Lee J, Lee S, Jang J, Kim J, Ok T . Metal versus plastic stents for drainage of malignant biliary obstruction before primary surgical resection. Gastrointest Endosc. 2016; 84(5):814-821. DOI: 10.1016/j.gie.2016.04.018. View

Kapoor B, Mauri G, Lorenz J . Management of Biliary Strictures: State-of-the-Art Review. Radiology. 2018; 289(3):590-603. DOI: 10.1148/radiol.2018172424. View

Matsushita M, HAJIRO K, Takakuwa H, Nishio A . Are biliary stents placed above the sphincter of oddi really ineffective?. Gastrointest Endosc. 2000; 51(1):116-7. DOI: 10.1016/s0016-5107(00)70149-0. View

Inamdar S, Slattery E, Bhalla R, Sejpal D, Trindade A . Comparison of Adverse Events for Endoscopic vs Percutaneous Biliary Drainage in the Treatment of Malignant Biliary Tract Obstruction in an Inpatient National Cohort. JAMA Oncol. 2015; 2(1):112-7. DOI: 10.1001/jamaoncol.2015.3670. View

Paik W, Woo S, Chun J, Song B, Lee W, Ahn D . Efficacy of an internal anchoring plastic stent to prevent migration of a fully covered metal stent in malignant distal biliary strictures: a randomized controlled study. Endoscopy. 2020; 53(6):578-585. DOI: 10.1055/a-1256-0571. View

Arhan M, Odemis B, Parlak E, Ertugrul I, Basar O . Migration of biliary plastic stents: experience of a tertiary center. Surg Endosc. 2008; 23(4):769-75. DOI: 10.1007/s00464-008-0067-x. View

Bordacahar B, Perdigao F, Leblanc S, Barret M, Duchmann J, Guillaumot M . Clinical efficacy of anti-migration features in fully covered metallic stents for anastomotic biliary strictures after liver transplantation: comparison of conventional and anti-migration stents. Gastrointest Endosc. 2018; 88(4):655-664. DOI: 10.1016/j.gie.2018.06.035. View

10.

Leng J, Zhang N, Dong J . Percutaneous transhepatic and endoscopic biliary drainage for malignant biliary tract obstruction: a meta-analysis. World J Surg Oncol. 2014; 12(1):272. PMC: 6389255. DOI: 10.1186/1477-7819-12-272. View

11.

Yuan X, Ye L, Liu Q, Wu C, Liu W, Zeng X . Risk factors for distal migration of biliary plastic stents and related duodenal injury. Surg Endosc. 2019; 34(4):1722-1728. PMC: 7093356. DOI: 10.1007/s00464-019-06957-x. View

12.

Lee T, Moon J, Park S . Biliary stenting for hilar malignant biliary obstruction. Dig Endosc. 2019; 32(2):275-286. DOI: 10.1111/den.13549. View

13.

Pedersen F, Lassen A, Schaffalitzky de Muckadell O . Randomized trial of stent placed above and across the sphincter of Oddi in malignant bile duct obstruction. Gastrointest Endosc. 1998; 48(6):574-9. DOI: 10.1016/s0016-5107(98)70038-0. View

14.

Taj M, Ghazanfar S, Qureshi S, Zubair M, Niaz S, Quraishy M . Plastic stent migration in ERCP; a tertiary care experience. J Pak Med Assoc. 2019; 69(8):1099-1102. View

15.

Kaneko T, Sugimori K, Shimizu Y, Miwa H, Kameta E, Koh R . Efficacy of plastic stent placement inside bile ducts for the treatment of unresectable malignant hilar obstruction (with videos). J Hepatobiliary Pancreat Sci. 2013; 21(5):349-55. DOI: 10.1002/jhbp.41. View

16.

Coelen R, Roos E, Wiggers J, Besselink M, Buis C, Busch O . Endoscopic versus percutaneous biliary drainage in patients with resectable perihilar cholangiocarcinoma: a multicentre, randomised controlled trial. Lancet Gastroenterol Hepatol. 2018; 3(10):681-690. DOI: 10.1016/S2468-1253(18)30234-6. View

17.

Deprez P, Moreels T, Aouattah T, Piessevaux H, Perez-Cuadrado-Robles E . A new 12-French plastic stent for unresectable distal malignant biliary obstruction. Endoscopy. 2020; 52(6):474-482. DOI: 10.1055/a-1120-8498. View

18.

Kuwatani M, Kawakubo K, Sakamoto N . Possible reasons for the regrettable results of patency of an inside stent in endoscopic transpapillary biliary stenting. Dig Endosc. 2021; 34(2):334-344. DOI: 10.1111/den.14006. View

19.

Xia M, Cai X, Pan Y, Wu J, Gao D, Ye X . Optimal stent placement strategy for malignant hilar biliary obstruction: a large multicenter parallel study. Gastrointest Endosc. 2019; 91(5):1117-1128.e9. DOI: 10.1016/j.gie.2019.12.023. View

20.

Tomoda T, Kato H, Kawamoto H, Muro S, Akimoto Y, Uchida D . Usefulness of a newly designed plastic stent for endoscopic re-intervention in patients with malignant hilar biliary obstruction. Endoscopy. 2017; 49(11):1087-1091. DOI: 10.1055/s-0043-116215. View