The Clinical Efficacy of Percutaneous Bilateral Internal Drainage in Advanced Hilar Malignancy by T-Configured Dual Stent Placement: Comparison with Unilateral Endoscopic Stent Placement

Lee, Joo Ho; Lee, Sang Yong; Lee, Jung Hyun; Jung, Hyo Jin; Kim, Tae Oh; Kim, Gwang Ha; Heo, Jeong; Kang, Dae Hwan; Song, Geun Am; Cho, Mong; Kim, Suk; Kim, Chang Won; Lee, Suk Hong

Abstract

BACKGROUND/AIMS: Endoscopic or percutaneous internal drainage is a well-established palliative treatment for unresectable biliary tumors. Previous studies dealing with the unilateral versus bilateral liver lobe drainage have reported inconsistent results. This study evaluated the clinical efficacy of bilateral drainage with a newly designed T configured dual stent (T-stent) placement.
METHODS
From 2001 to 2004, 46 hilar malignancies, which were not suitable for endoscopic retrograde biliary drainage (ERBD) on MR cholangiography were treated with the percutaneous placement of two self-expandable metallic endoprostheses in a T configuration through a single transhepatic access. The outcomes were examined retrospectively. The hilar malignancies, which were drain ed by unilateral ERBD were also reviewed.
RESULTS
The 46 hilar malignancies drained by a T stent included a cholangiocarcinoma (n=36), gallbladder cancer (n=6), and metastatic cancer (n=4). Procedure related cholangitis occurred in 3 out of 46 patients (6.5%). The mean survival and stent patency times were 256 and 194 days, respectively. The 34 hilar malignancies drained by unilateral ERBD included cholangiocarcinoma (n=29), gallbladder cancer (n=3), and pancreatic cancer (n=2). Procedure related cholangitis occurred in 7 out of 34 patients (20.6%). The mean survival and stent patency times were 292 and 186 days, respectively. There were no statistically significant differences in the cholangitis frequency, survival and stent patency between the two groups. The frequency of cholangitis, mean survival and patency time in Klatskin tumors, which were drained by the T-stent (n=36) and ERBD (n=29), were compared. There were no significant differences in survival and stent patency time.
CONCLUSIONS
T-configured dual stent placement can be used effectively in advanced biliary hilar malignancies. It can be used as a safe palliative drainage method in advanced hilar tumors, which are not suitable for ERBD.