Original ArticlesSelective MRCP and CT-targeted drainage of malignant hilar biliary obstruction with self-expanding metallic stents☆,☆☆
Section snippets
Patients and methods
Over a period of 5 years, all patients undergoing ERCP by a single endoscopist (M.L.F.) for attempted palliative therapy of biliary obstruction resulting from malignant hilar lesions were entered into the study, which was approved by the institutional review board of our medical center. Informed consent was obtained from all patients or nearest relative at the time of initial ERCP and before final follow-up. Tumors were considered to be hilar if the stricture was within 1 cm of the hepatic
Results
A total of 37 patients underwent one or more ERCP procedures for malignant hilar biliary obstruction by one endoscopist (M.L.F.) during a 5-year interval. One patient underwent surgical resection and one debulking of the primary tumor, and both were excluded from analysis. The remaining 35 patients (19 men, 16 women; median age 65 years [interquartile range (IQR) 55-74]; range 36-85 years) in whom endoscopic palliation with metallic stents was intended are included in the analysis. Seven were
Discussion
The results of this study suggest that use of MRCP and/or CT to selectively target endoscopic placement of unilateral metallic stents into the largest intercommunicating group of intrahepatic ducts provides effective palliation with minimal risk of complications for most patients with malignant hilar biliary obstruction. In rare cases in which ERCP was impossible, similarly targeted unilateral percutaneous stent placement also provided effective drainage. This selective approach resulted in
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Reprint requests: Martin L. Freeman, MD, University of Minnesota, Division of Gastroenterology, Hennepin County Medical Center, 701 Park Ave., Minneapolis, MN 55415.
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0016-5107/2003/$30.00 + 0