Selective intrahepatic duct cannulation by using a triple-lumen catheter for endoscopic bilateral stenting in hilar cholangiocarcinoma

Background Selective cannulation of the intrahepatic duct is essential for endoscopic management of hilar cholangiocarcinoma, but it can be very difficult to achieve. Preexisting methods are sometimes time consuming and have limited success. Objective To evaluate the effectiveness of a triple-lumen catheter for selective cannulation in the intrahepatic ducts of patients with hilar cholangiocarcinoma. Design Retrospective analysis of a prospective database. Setting Tertiary-care referral university hospital. Patients This study involved 58 patients with unresectable hilar cholangiocarcinoma (Bismuth types II-IV), in whom attempts were made to insert bilateral stents endoscopically. Intervention After conventional cannulation methods failed, selective cannulation with a triple-lumen catheter was tried. Main Outcome Measurements Selective cannulation of the left or right intrahepatic duct. Results With the triple-lumen catheter, the rates of successful selective intrahepatic duct cannulation increased from 97% (56/58 patients) to 100% (58/58 patients) in the first stent (Y stent) placement site and from 78% (45/58 patients) to 91% (53/58 patients) in the second (contralateral stent) placement site. Selective cannulation with the triple-lumen catheter was achieved in 10 of 15 patients (67%) in whom conventional methods failed. When the triple-lumen catheter was used, the success rate of guidewire insertion into the bilateral intrahepatic ducts was increased from 74% (43 patients) to 91% (53 patients). Limitations Retrospective, single-center study. Conclusions Use of the triple-lumen catheter appears to be an effective method for selective cannulation of intrahepatic ducts. It can be considered as a valuable method for selective cannulation in patients with hilar cancer in whom conventional methods have failed.