Endoscopic bilateral metal stent placement for malignant hilar stenoses: identification of optimal technique

Background: The aim of this study was to identify factors that facilitate b ilateral insertion of metal stents in malignant hilar stenoses, for which p lastic stents often result in incomplete drainage and subsequent cholangiti s. Methods: Between January 1994 and April 1998, we collected 45 cases of adva nced (Bismuth stage II or higher) hilar malignant stenoses. The insertion t echnique was progressively modified and the success rate in the early perio d (1994 to 1995) was compared with that of a later period (1996) and the mo st recent period (1997 to 1998). Results: Overall success rate was 73.3% (33 of 45), The success rates for t he three periods were 50%, 67%, and 88% (p = 0.008), respectively. Cholangi tis occurred in 3 of the patients with unilateral stents compared with 1 wi th bilateral stents. Conclusion: We have described a technique for endoscopic insertion of bilat eral metallic stents for malignant hilar stenoses that results in high (>88 %) and reproducible success rates.