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

Background Although 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. Objective To evaluate the technical and clinical efficacy of endoscopic placement of dual, newly designed stents in a Y configuration. Design Prospective, uncontrolled, single center. Setting Tertiary referral university hospital. Patients Ten patients with unresectable hilar cholangiocarcinoma of Bismuth type II or higher. Interventions For 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 Measurement Technical success, functional success, early complications, and short-term clinical outcome. Results Technical 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. Limitations Small number of patients, uncontrolled study, short-term follow-up period. Conclusions We 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%.