Endoscopic bilateral metal stent placement for advanced hilar cholangiocarcinoma: a pilot study of a newly designed Y stent

BackgroundAlthough endoscopic stent placement is now generally accepted as a palliative method of treatment in unresectable hilar cholangiocarcinoma, exclusively endoscopic placement of bilateral metal stents has been considered very difficult and complex.ObjectiveTo evaluate the technical and clinical efficacy of endoscopic placement of dual, newly designed stents in a Y configuration.DesignProspective, uncontrolled, single center.SettingTertiary referral university hospital.PatientsTen patients with unresectable hilar cholangiocarcinoma of Bismuth type II or higher.InterventionsFor bilateral metal stent placement, a biliary Y stent with central wide-open mesh was used exclusively at first. A second stent was placed into the contralateral hepatic duct through the central open mesh of the Y stent.Main Outcome MeasurementTechnical success, functional success, early complications, and short-term clinical outcome.ResultsTechnical success was achieved in 8 of 10 patients (80%). Among 8 patients in whom bilateral stents were successfully placed by endoscopy, functional success was 100%, the early complication rate was 0%, and the stent occlusion rate was 25%. The median stent patency period was 217 days.LimitationsSmall number of patients, uncontrolled study, short-term follow-up period.ConclusionsWe described a technique for endoscopic bilateral metal stent placement by using the newly designed Y stent for advanced hilar cholangiocarcinoma that resulted in a high success rate of 80%.