Korean J Radiol.  2015 Jun;16(3):586-592. 10.3348/kjr.2015.16.3.586.

Percutaneous Unilateral Biliary Metallic Stent Placement in Patients with Malignant Obstruction of the Biliary Hila and Contralateral Portal Vein Steno-Occlusion

• Son RC
• Gwon DI
• Ko HK
• Kim JW
• Ko GY

• KMID: 2155528
• DOI: http://doi.org/10.3348/kjr.2015.16.3.586

Abstract

OBJECTIVE
To investigate the outcomes of percutaneous unilateral metallic stent placement in patients with a malignant obstruction of the biliary hila and a contralateral portal vein steno-occlusion.
MATERIALS AND METHODS
Sixty patients with a malignant hilar obstruction and unilobar portal vein steno-occlusion caused by tumor invasion or preoperative portal vein embolization were enrolled in this retrospective study from October 2010 to October 2013. All patients were treated with percutaneous placement of a biliary metallic stent, including expanded polytetrafluoroethylene (ePTFE)-covered stents in 27 patients and uncovered stents in 33 patients.
RESULTS
A total of 70 stents were successfully placed in 60 patients. Procedural-related minor complications, including self-limiting hemobilia (n = 2) and cholangitis (n = 4) occurred in six (10%) patients. Acute cholecystitis occurred in two patients. Successful internal drainage was achieved in 54 (90%) of the 60 patients. According to a Kaplan-Meier analysis, median survival time was 210 days (95% confidence interval [CI], 135-284 days), and median stent patency time was 133 days (95% CI, 94-171 days). No significant difference in stent patency was observed between covered and uncovered stents (p = 0.646). Stent dysfunction occurred in 16 (29.6%) of 54 patients after a mean of 159 days (range, 65-321 days).
CONCLUSION
Unilateral placement of ePTFE-covered and uncovered stents in the hepatic lobe with a patent portal vein is a safe and effective method for palliative treatment of patients with a contralateral portal vein steno-occlusion caused by an advanced hilar malignancy or portal vein embolization. No significant difference in stent patency was detected between covered and uncovered metallic stents.

Keyword

Biliary tract; Malignancy; Portal vein; Stent

MeSH Terms

Adult
Aged
Aged, 80 and over
Biliary Tract Neoplasms/surgery
Cholangitis/etiology
Cholestasis/*surgery
Female
Hemobilia/etiology
Humans
Kaplan-Meier Estimate
Liver/blood supply/pathology/surgery
Liver Neoplasms/surgery
Male
Middle Aged
Palliative Care/methods
Polytetrafluoroethylene
Portal Vein/pathology/*surgery
Retinal Vein Occlusion/*surgery
Retrospective Studies
Stents/*adverse effects
Treatment Outcome
Polytetrafluoroethylene

Figure

• 

  Fig. 1 60-year-old man with Klatskin tumor (Bismuth type IV) and left portal vein occlusion (not shown). A. Computed tomography scan obtained before percutaneous transhepatic biliary drainage shows dilatation of both intrahepatic bile ducts and patent right portal vein (black arrow). B. Cholangiogram through right-side drainage catheter shows stricture of right anterior and posterior intrahepatic bile ducts (white arrows) and proximal common bile duct (empty arrow). Left intrahepatic bile duct was not opacified by contrast medium. C. Cholangiogram obtained after inserting stent shows good passage of contrast medium through stent.

• 

  Fig. 2 55-year-old man with intrahepatic cholangiocarcinoma (Bismuth type IV) and left portal vein occlusion (not shown). A. Computed tomography scan obtained before percutaneous transhepatic biliary drainage shows dilatation of both intrahepatic bile ducts and patent right portal vein (black arrow). B. Cholangiogram through right anterior and posterior intrahepatic bile duct drainage catheters shows stricture of right anterior and posterior intrahepatic bile ducts (white arrows) and common hepatic duct (empty arrow). Left intrahepatic bile duct was not opacified by contrast medium. C. Cholangiogram obtained after inserting Y-configured stent shows good passage of contrast medium through stent.

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  Fig. 3 Life-table analysis shows survival rates of patients treated with percutaneous unilateral, metallic stents. Cross-hatch indicates censored events.

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  Fig. 4 Life-table analysis shows patency rate of percutaneous unilateral metallic stents. Cross-hatch indicates censored events.

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  Fig. 5 Kaplan-Meier curves reveal no difference in cumulative stent patency between groups. Cross-hatch indicates censored events.

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