Selective MRCP and CT-targeted drainage of XXXX with self-expanding metallic stents.

@entity1 @entity1087 @entity5 @entity1126 @entity201 @entity1535 @entity255
BACKGROUND: Endoscopic management of @entity5 is controversial with respect to optimal types of stents and extent of drainage. This study evaluated outcomes of selective MRCP and CT-targeted drainage with self-expanding metallic stents. METHODS: Consecutive @entity1 undergoing attempted palliative ERCP for @entity5 were prospectively followed. Whenever possible, management strategy included evaluation and staging for potential resectability before ERCP, with primary placement of metallic stents at the first ERCP in nonsurgical candidates, and early conversion to a metallic stent when a @entity5 proved to be unresectable. MRCP and/or CT were used to plan selective guidewire access, opacification, and drainage only of the largest intercommunicating segmental ducts. Unilateral stent placement was intended in all cases except for selected @entity1 with @entity201 . RESULTS: Thirty-five @entity1 were included. Bismuth classification was I, 10; II, 6; III, 8; and IV, 11. Tumor origin was bile duct (17), gallbladder (5), and metastatic (13). Metallic stents were placed in 27 @entity1 as the initial stent, and in 8 after plastic stent placement. Initial stents were placed endoscopically in 33 @entity1 and percutaneously in 2 @entity1 in whom @entity5 precluded ERCP. Stent placement was unilateral in 31 @entity1 and bilateral in 4 @entity1 . There were no episodes of @entity255 or other complications within 30 days after any procedures. Initial metallic stents were clinically effective in 27 (77%) of the 35 @entity1 . Additional percutaneous drainage in 3 @entity1 who did not respond to initial stent placement did not resolve @entity1087 . Median patency of first metallic stents was 8.9 months for @entity1 with @entity1126 and 5.4 months for all @entity1 , and was not related to @entity1535 classification. No further intervention was needed in 25 (71%) @entity1 . CONCLUSIONS: Unilateral metallic stent placement by using MRCP and/or CT to selectively target drainage provides safe and effective palliation in most @entity1 with @entity5 .
