Percutaneous Biliary Metallic Stent Placement in Patients With Unilobar Portal Vein Occlusion Caused by Advanced Hilar Malignancy: Outcome of Unilateral Versus Bilateral Stenting

• Published in: American journal of roentgenology (1976) Vol. 197; no. 4; pp. 795 - 801
• Main Authors: II GWON, Dong, KO, Gi-Young, SUNG, Kyu-Bo, YOON, Hyun-Ki, JI HOON SHIN, JIN HYOUNG KIM, KIM, Jinoo, JI YOUNG OH
• Format: Journal Article
• Language: English
• Published: Reston, VA American Roentgen Ray Society 01-10-2011
• Subjects: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms - complications; Bile Ducts, Intrahepatic - pathology; Biological and medical sciences; Female; Humans; Male; Medical sciences; Metals; Middle Aged; Portal Vein - pathology; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Statistics, Nonparametric; Stents; Treatment Outcome; Venous Thrombosis - etiology; Venous Thrombosis - surgery; Human; Biliary tract; Prognosis; malignancy; Digestive system; Instrumentation therapy; Instrumental dilatation; Malignant tumor; Stent; Percutaneous route; Portal vein; Comparative study; Cancer
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/AJR.11.6424

The purpose of this study was to investigate the outcome of biliary metallic stent placement in patients with contralateral portal vein occlusion caused by advanced hilar malignancy and to compare the outcomes of unilateral and bilateral stent placement.
From January 2007 to December 2009, 41 patients with unilobar portal vein occlusion due to advanced hilar malignancy were enrolled in this retrospective study. All patients were treated with percutaneous placement of biliary metallic stents: unilateral stent placement in 23 patients, bilateral stent placement in 18 patients.
There were no significant differences in technical success (p > 0.999), successful drainage (p > 0.999), early cholangitis (p = 0.734), stent occlusion (p = 0.713), stent patency (p = 0.653), or patient survival (p = 0.493) between the two groups. In the patients who underwent unilateral stent placement, a slight decrease in diameter (mean diameter, 7.2 ± 3 mm before drainage, 6.2 ± 3 mm after stent placement) (p = 0.058) was observed in the intrahepatic bile duct of the undrained lobe with portal vein occlusion. Four of the patients who underwent unilateral stent placement had stent malfunctions, but the other 19 patients did not experience cholangitis or jaundice before death or the end of the study.
Unilateral biliary metallic stent placement in the lobe with a patent portal vein seems to be a safe and effective palliative treatment of patients with contralateral portal vein occlusion caused by advanced hilar malignancy, obviating bilateral stent placement in these patients.