Management of Advanced Hilar Biliary Malignancy with X-shaped Stenting Technique.
10.3348/jkrs.2000.42.6.919
- Author:
Gyu Hyuk HWANG
1
;
Jin Jong YOU
;
In Oak AHN
;
Jae Boem NA
;
Sung Hoon CHUNG
Author Information
1. Department of Radiology, Gyeongsang National University, College of Medicine.
- Publication Type:Original Article
- Keywords:
Bile ducts,neoplasms;
Bile ducts, stenosis or obstruction;
Bile ducts,interventional procedure;
Bile ducts, stents and prostheses;
Stents and prostheses
- MeSH:
Ascites;
Bile;
Bile Ducts, Intrahepatic;
Bilirubin;
Cholangiocarcinoma;
Dilatation;
Hemobilia;
Humans;
Punctures;
Sepsis;
Stents*
- From:Journal of the Korean Radiological Society
2000;42(6):919-924
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To report X-shaped stent insertion and its result in the patients with advanced hilar malignancy. MATERIALS AND METHODS:X-shaped stents were inserted in six patients with advanced hilar malignancy involving segmental branches of both intrahepatic bile ducts (IHD). The causes were cholangiocarcinomas in five patients and recurrent GB cancer in one. The procedure includes three steps: 1) the insertion of two wires through three IHDs in an X configuration, using a stone basket; 2) balloon dilatation of lesions, and 3) the in-sertion of two stents in an as X configuration. Stents were inserted after balloon dilatation in five patients, and without balloon dilatation in one. Changes in serum bilirubin levels and procedure-related problems were reviewed. RESULTS: In all patients, serum bilirubin levels gradually decreased, but in two, they increased again. One of these two died of sepsis after 1 month. There was bile leakage through the puncture and bile was extracted from malignant ascites. In the other patient, occlusion of the left stent tip occurred, and additional left PTBD was performed 3 months later. Hemobilia developed in all five patients with balloon dilatation, these all experianced pain during dilatation , but afterwards this disappeared. One stent without pre-balloon dilation showed incomplete self-expansion at the crossing part and supplementary balloon dilatations were performed. CONCLUSION: In patients with advanced hilar malignancy, X-shaped stent insertion is a new palliation. Problems such as hemobilia, pain, and intraperitoneal bile leakage may, however, occur.
