• Biomarker
• Distal cholangiocarcinoma
• Pancreatoduodenectomy
• Prognosis
• Systemic inflammatory response index

• Complication
• biliary drainage
• infection
• percutaneous

• Humans
• Retrospective Studies
• Drainage
• Cholestasis/etiology
• Cholestasis/therapy
• Outpatients

• Cholangiopancreatography
• Cholecystitis
• Cholecystostomy
• Health care costs
• Inpatients
• acute
• endoscopic retrograde

• Antibiotic prophylaxis
• bacteremia
• biliary tract infections
• percutaneous transhepatic cholangiography

• adequate bilirubin decline (ABD)
• biliary drainage
• jaundice
• malignant obstruction

• Biliary brachytherapy
• Complications
• Endoluminal brachytherapy
• Esophageal brachytherapy
• Intraluminal brachytherapy
• Liver brachytherapy
• Pancreatic brachytherapy
• Toxicity

• Brachytherapy/methods
• Deglutition Disorders
• Esophageal Neoplasms/complications
• Esophageal Neoplasms/radiotherapy
• Humans
• Palliative Care
• Upper Gastrointestinal Tract

• Cholangiocarcinoma
• biliary obstruction
• endoscopic ultrasound
• pancreatic cancer
• stent
• stricture

• adult palliative care
• hepatobiliary tumours
• interventional radiology

• Aged
• Aged, 80 and over
• Bile Duct Neoplasms/complications
• Bile Duct Neoplasms/diagnosis
• Bile Duct Neoplasms/epidemiology
• Cholangiography/methods
• Drainage/methods
• England/epidemiology
• Female
• Follow-Up Studies
• Humans
• Incidence
• Jaundice, Obstructive/diagnosis
• Jaundice, Obstructive/etiology
• Jaundice, Obstructive/surgery
• Male
• Middle Aged
• Palliative Care/methods
• Quality of Life
• Retrospective Studies
• Surgery, Computer-Assisted/methods
• Survival Rate/trends
• Treatment Outcome

• distal biliary stricture
• palliative biliary drainage
• pancreaticobiliary malignancy
• preoperative biliary drainage
• self-expandable metal stent

To investigate the technical safety and clinical efficacy of a double-stent system with long duodenal extension in patients with malignant extrahepatic biliary obstruction.

This prospective study enrolled 48 consecutive patients (31 men, 17 women; mean age, 61 years; age range, 31–77 years) with malignant extrahepatic biliary obstructions from May 2013 to December 2015. All patients were treated with a double-stent system with long duodenal covered extension (16 cm or 21 cm).

The stents were successfully placed in all 48 patients. There were five (10.4%) procedure-related complications. Minor complications were self-limiting hemobilia (n = 2). Major complications included acute pancreatitis (n = 1) and acute cholecystitis (n = 2). Successful internal drainage was achieved in 42 (87.5%) patients. Median patient survival and stent patency times were 92 days (95% confidence interval [CI], 61–123 days) and 83 days (95% CI, 46–120 days), respectively. Ten (23.8%) of the 42 patients presented with stent occlusion due to food impaction with biliary sludge, and required repeat intervention. Stent occlusion was more frequent in metastatic gastric cancer patients with pervious gastrectomy, but did not reach statistical significance (p = 0.069).

Percutaneous placement of a double-stent system with long duodenal extension is feasible and safe. However, this stent system does not completely prevent stent occlusion caused by food reflux.

• Biliary
• Malignancy
• Obstruction
• Stent

This study aimed to compare two self-expanding stents, a nitinol stent and an elgiloy stent, both placed percutaneously, in terms of their efficacy in palliating inoperable malignant biliary obstruction.

We retrospectively investigated 99 patients with unresectable malignant biliary obstruction treated with percutaneous placement of a self-expanding metallic stent at our institution between May 2007 and January 2010. Serum bilirubin and liver enzyme levels were measured before and 30 days after stenting. For all procedures using elgiloy or nitinol stents, stent occlusion and patient survival rates were calculated using Kaplan-Meyer analysis.

All of the patients showed clinical improvement after stent placement, with no difference between the two groups. In both groups, the occlusion-free survival rate was 67% at 30 days, 37% at 90 days, 25% at 180 days, and 10% at 360 days, with no significant difference in relation to the type of stent.

The two stents evaluated showed comparable efficacy for the percutaneous treatment of unresectable biliary malignancy, with good clinical results.

• Biliary tract/pathology
• Drainage
• Oncology
• Radiology, interventional
• Stents

• Aged
• Aged, 80 and over
• Bile Duct Neoplasms/complications
• Bile Ducts, Intrahepatic
• Cholangiopancreatography, Endoscopic Retrograde
• Cholestasis, Intrahepatic/etiology
• Cholestasis, Intrahepatic/therapy
• Drainage/methods
• Female
• Humans
• Male
• Middle Aged
• Palliative Care/methods
• Prospective Studies
• Treatment Outcome

• Biliary strictures
• Endoscopic retrograde cholangiopancreatography
• Endoscopic ultrasound
• Endoscopy
• Malignant
• Palliation
• Photodynamic therapy
• Radiofrequency ablation

• EUS-guided biliary drainage
• Failed ERCP
• Interventional EUS
• SEMSs
• choledochoduodenostomy

• Bile duct malignancy
• Gallbladder malignancy
• Jaundice
• Malignant
• Palliative care
• Pancreas malignancy
• Stents

• Biliary Tract Neoplasms/surgery
• Biliary Tract Surgical Procedures/instrumentation
• Biliary Tract Surgical Procedures/methods
• Cholestasis/pathology
• Cholestasis/surgery
• Drainage
• Humans
• Palliative Care/methods
• Stents

• endoscopic biliary drainage
• malignant biliary tract obstruction
• meta-analysis
• percutaneous transhepatic biliary drainage

Various malignant tumors can obstruct the extrahepatic biliary tract. Two major techniques for restoring bile flow in this circumstance are endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD).We conducted a meta-analysis to compare the effectiveness and safety of the two techniques.

Medline, EMBASE and the Cochrane Library database were searched for articles published between January 1980 and December 2013. The outcome measures were therapeutic success rate (primary), 30-day mortality rate and overall complications.

Of 264 screened articles, 3 randomized controlled trials comprising an aggregate total of 183 cancer patients were included in the meta-analysis. Our analysis showed no significant difference in restoration of bile flow between patients treated with EBD and those treated with PTBD (odds ratio (OR) = 2.34, 95% confidence interval (CI) = 0.32 to 17.16, P = 0.401). However, the result of sensitivity analysis indicated that the study conducted by Speer et al. influenced the pooled estimates. After the Speer et al. study was excluded, the therapeutic success rate of patients treated with PTBD was significantly greater than that of those who underwent EBD (OR = 5.48, 95% CI: 2.26 to 13.28, P < 0.001). The 30-day mortality and complication rates were similar in the EBD and PTBD groups.

The results of our meta-analysis indicate that PTBD had a higher therapeutic success rate than EBD in the treatment of malignancy-induced biliary obstruction. The mortality and complication rates of the two techniques were similar.

The online version of this article (doi:10.1186/1477-7819-12-272) contains supplementary material, which is available to authorized users.

To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy.

Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated.

The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL ± 6.8 before stent insertion, decreased to 4.58 mg/dL ± 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 ± 99 days, and the median patient survival was 179 ± 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009).

Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.

• Biliary tract, interventional procedures
• Biliary tract, malignant obstruction
• Gastric carcinoma
• Prosthesis, stent

The aim of this study was to evaluate the effect of percutaneous one-channel double stent implantation on hilar biliary obstruction involving both hepatic ducts and its clinical value. A total of 8 patients with hilar biliary obstruction involving the left and right hepatic ducts were enrolled. A percutaneous unilateral approach was adopted. Two stents were implanted, one between the left and right hepatic ducts and the other between the hepatic ducts and the common bile duct for biliary drainage. Interventional therapies such as arterial chemoembolization were performed for antitumor treatment. All surgical procedures were successfully accomplished. At 2 weeks after stenting, total bilirubin decreased to 61.2±13.4 μmol/l (the preoperative value was 267.1±154.7 μmol/l). No severe complications or mortalities occurred. Single-channel double stent implantation should be the preferred method of treatment for patients with hilar biliary obstruction involving both hepatic ducts. Drainage and antitumor treatment should also be used when necessary.

• antitumor
• biliary obstruction
• double stents
• single channel