Endoscopy 2016; 48(06): 536-545
DOI: 10.1055/s-0042-102651
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Risk factors for recurrent biliary obstruction following placement of self-expandable metallic stents in patients with malignant perihilar biliary stricture

Shin Miura
1   Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Atsushi Kanno
1   Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Atsushi Masamune
1   Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Shin Hamada
1   Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Seiji Hongou
1   Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Naoki Yoshida
1   Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Eriko Nakano
1   Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Tetsuya Takikawa
1   Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Kiyoshi Kume
1   Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Kazuhiro Kikuta
1   Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Morihisa Hirota
1   Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Hiroshi Yoshida
2   Division of Hepato-Biliary-Pancreatic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Yu Katayose
2   Division of Hepato-Biliary-Pancreatic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Michiaki Unno
2   Division of Hepato-Biliary-Pancreatic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Tooru Shimosegawa
1   Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
› Author Affiliations
Further Information

Publication History

submitted 16 February 2015

accepted after revision 29 December 2015

Publication Date:
17 March 2016 (online)

Preview

Background and study aim: Self-expandable metallic stents (SEMSs) are used for palliation in patients with malignant perihilar biliary strictures. However, recurrent biliary obstruction occasionally causes cholangitis and jaundice. This study aimed to identify risk factors for recurrent biliary obstruction in such patients.

Methods: Data from consecutive patients with malignant perihilar biliary strictures treated with endoscopic placement of SEMSs between 2007 and 2014 in Tohoku University Hospital were retrospectively reviewed. Risk factors for recurrent biliary obstruction were calculated using the Cox proportional hazards models (with hazard ratios [HRs] and 95 % confidence interval [95 %CIs]), and SEMS patency period was examined using the Kaplan – Meier method. SEMS patency was defined as the period between SEMS insertion and the development of recurrent biliary obstruction.

Results: 104 patients were included. Median survival time was 281 days; and 85 patients died during a median follow-up period of 320 days. Recurrent biliary obstruction occurred in 35 patients. Median SEMS patency period was 549 days. Multivariable analyses showed that: compared with bile duct carcinoma, gallbladder carcinoma was associated with shorter SEMS patency (HR 8.18, 95 %CI 2.41 – 26.83); patency of left-sided SEMS was inferior to that of bilateral (HR 0.5, 95 %CI 0.32 – 0.93) and right-sided SEMS (HR 0.1, 95 %CI 0.02 – 0.65). Cholangitis before SEMS placement increased the risk of recurrent biliary obstruction (HR 11.44; 95 %CI 4.48 – 32.35) and reduced the SEMS patency period (746 vs. 210 days).

Conclusion: Gallbladder carcinoma, left-sided stent placement, and cholangitis before SEMS placement are risk factors for recurrent biliary obstruction after SEMS placement.