Endoscopic Deployment of Jostent Selfx for Malignant Hilar Biliary Stricture: A Pilot Study

Abstract

Endoscopic Deployment of Jostent Selfx for Malignant Hilar Biliary Stricture: A Pilot Study Hirofumi Kawamoto, Takashi Nakanishi, Osamu Mizuno, Etsuji Ishida, Tsuneyoshi Ogawa, Yuko Okamoto, Hirotoshi Fukatsu, Yasushi Shiratori Objectives: The JoStent SelfX stent (Abbott Vascular Devices, Redwood City, California, USA) is manufactured from a nickel-titanium alloy (nitinol) with a high degree of flexibility and elasticity. The JoStent SelfX also offers a wide stent mesh, thin delivery shaft, and good pushability. Therefore, the JoStent SelfX in endoscopic deployment of partial stent-in-stent procedure may be useful in case of the hilar biliary stricture. This pilot study was conducted to evaluate the procedure of stent deployment and its short-term stent efficacy. Methods: Between March 2003 and October 2004, 17 patients (male: female 9:8, mean age 67 year old, mean observation period 146 days) with malignant hilar biliary stricture admitted to our hospital were enrolled. The patients consisted of 11 patients with hilar bile duct carcinoma, 3 with gallbladder carcinoma, and one each patient with pancreas, colon, and hepatocellular carcinoma. All patients received JoStent SelfX endoscopically. The first stent was inserted into the left lateral segment as the stent mesh space was widest at the branching. After finding the right biliary branch through the stent mesh using Naviguide (Olympus, Tokyo, Japan), the second stent was inserted into this branch as a partial stent-in-stent procedure. This procedure was termed as ‘‘L-R pattern’’. When the patients had Bismuth type 4 stricture with large tumor in the left hepatic lobe or left portal vein obstruction, the first stent was inserted into the right posterior segment and the second stent was inserted into anterior branch. This procedure was termed as ‘‘Ra-p pattern’’. Results: Classifying the pattern of stenosis according to Bismuth classification, 1 patient had type 2 stenosis, 3 patients type 3 stenosis, and 13 patients type 4 stenosis. Of these, the L-R pattern deployment was performed in 11 patients and the Ra-p pattern deployment in 6 patients. On the intention-to-treat basis, the L-R pattern deployment was not achieved in 1 patient due to the failure of passing guidewire through the stenosis. Thus, the success rate of deployment was 94% (16/17). The Ra-p deployment was performed to this patient. Conclusion: The JoStent SelfX is a suitable metallic stent to deploy in the hilar biliary stricture in partial stent-in-stent procedure. T1274 Prospective Randomized Controlled Trial of Endoscopic Sphincterotomy Compared with Endoscopic Papillary Balloon Dilatation for Bile Duct Stones: Late Complications After Stone Removal Yutaka Komatsu, Naotaka Fujita, Hiroyuki Maguchi, Ichiro Yasuda, Osamu Hasebe, Yoshinori Igarashi, Akihiko Murakami, Hidekazu Mukai, Tsuneshi Fujii, Kenji Yamao, Kensei Maeshiro Aim: To compare long term complications of the two treatments, endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD), for bile duct stones, including stone recurrence. Methods: From March 2000 to March 2001, a randomized controlled trial was carried out involving 11 institutions. Two hundred eighty two patients who had bile duct stones less than 14 mm in minimum diameter on X-ray images were included in this study. Patients were randomized to EST or EPBD treatment groups. Follow-up data were collected by personal interview or telephone every year. Even if biliary events had not occurred, blood examination, abdominal ultrasound, MRCP and/or ERCP were performed to assess asymptomatic stone recurrence, as available. The clinical outcome after stone removal in three years was evaluated using Kaplan-Meier analysis supplemented by the log lank test. Results: See Table. Conclusion: Overall incidence of late complications in the EST group was higher than that in the EPBD group. Stone recurrence in the EST group was also more frequent than in the EPBD group. Furthermore, a higher rate of asymptomatic stone recurrence in EST group was proved by follow-up MRCP and/or ERCP. Further long-term follow-up study will elucidate the efficacy of both procedures. Abstracts