Efficacy of Y-shaped bilateral self-expandable metallic stent placement for the management of malignant hilar biliary strictures

Background
Malignant hilar stricture (MHS) is a clinical challenge because of the current therapeutic approach and poor prognosis. Although still controversial, bilateral stenting may be the best option for the palliative drainage of malignant hilar biliary obstruction. Recently, the self-expandable metallic stents have clarified more efficacy than plastic stents for the palliation of MHSs, with the bilateral stent-in-stent technique registering a high success rate. The aim of our investigation is to evaluate the technical and clinical efficacious of the endoscopic bilateral metal stenting using a biliary Y-stent for the management of MHS.
Patients and methods
Twenty-five patients with advanced hilar cholangiocarcinoma were managed by Y-shaped bilateral self-expandable metallic stent placement. The prospective analysis was performed over a period of 3 years from May 2015 to June 2018 at the Department of General Surgery, Zagazig University Hospitals.
Intervention
For bilateral metal stent placement, a biliary Y-stent with central wide-open mesh was used exclusively at first. A second stent was placed into the contralateral hepatic duct through the central open mesh of the Y-stent.
Results
Bilateral metal stenting using a Y-stent technique successful was achieved in 23 of 25 patients (technical success, 92%), and successful drainage was achieved in all patients (100%). Early complications rate was 0%, and the stent occlusion rate was two (9%) of 23 patients. Two patients were managed with the insertion of a plastic stent through the occluded metal stent, and the remaining patients were treated with percutaneous biliary drainage. The median stent patency period was 221 days (range, 102–480 days).
Conclusions
The Y-shaped endoscopic bilateral stenting using a Y-stent is more effective and feasible method with a high technical success rate of 92% and low stent-related complications for the management of MHS.