The Management of High-Grade Hilar Strictures by Endoscopic Insertion of Self-Expanding Metal Endoprostheses

摘要: Background and Study Aims: Treatment options for un-resectable hepatic hilar strictures include percutaneous or endoscopic stent insertion, using either standard Teflon self-expanding metal endoprostheses. The use of stents is complicated by migration high occlusion rates. Published series endoscopically placed have not concentrated on their in the treatment high-grade (Bismuth grades II III). We therefore undertook a prospective open pilot study to evaluate efficacy endoprostheses palliation jaundice due strictures. Patients Methods: Self-expanding were 17 patients (nine women, eight men; median age 64 years, range 33-77). Of malignancies 11 (65%) had diagnosis cholan-giocarcinoma, 12 (71%) Bismuth grade III Results: inserted successfully all patients. Adequate drainage, as demonstrated significant reduction bilirubin, was achieved 15 (88 %); two whom drainage failed extensive intrahepatic disease. Early complications (cholangitis) developed one patient (6%), there seven late (41 %) five (four occluded three cases duodenal compression). patency appeared be prolonged (median months, 1.5-24 surviving months more). survival ten (range 1-48 months) after insertion. All died during follow-up. Conclusions: These results suggest that offer effective malignancies, although controlled trials comparing this group are required.