ASGE Endoscopy Course at ACG: Everyday Endoscopy: Expertise Meets Evidence | October 2024-10_Freeman

10_Freeman_HilarTumorStenting

Pdf Summary

The document discusses the advantages of using metal stents over plastic stents for treating hilar tumors, specifically in cases of hilar cholangiocarcinoma. Dr. Martin L. Freeman argues that metal stents, when placed optimally, offer superior patency compared to plastic stents. Key benefits include fewer repeat interventions, superior drainage, and the ability for adjunctive treatment options without complications such as caging.<br /><br />The document presents two case studies to illustrate these points. The first case involves a 77-year-old man with advanced hilar cholangiocarcinoma, previously managed with plastic stents, enduring multiple Endoscopic Retrograde Cholangiopancreatographies (ERCPs) and episodes of cholangitis over four years. After transitioning to metal stents, his condition stabilized, requiring no further ERCPs or cholangitis episodes in the following year. This case highlights the enhanced durability and reduced maintenance associated with metal stents.<br /><br />The second case details an 84-year-old man with metastatic prostate carcinoma and a new diagnosis of hilar cholangiocarcinoma. Metal stents, used in conjunction with chemotherapy and immunotherapy, provided effective biliary drainage and allowed for additional treatment of gastric outlet obstruction without issues. This patient maintained a good quality of life with minimal medical intervention years after the initial diagnosis.<br /><br />The document emphasizes that well-positioned metal stents, particularly Y-shaped stents placed suprapapillary, are advantageous due to their extended durability, reduced need for repeat procedures, and improved quality of life for patients with hilar tumors. These findings support the case for metal stents as a more effective option for managing hilar cholangiocarcinoma, underscoring their clinical and practical benefits as corroborated by the evidence from both cases presented.

Keywords

metal stents

plastic stents

hilar tumors

cholangiocarcinoma

patency

ERCP

biliary drainage

Y-shaped stents

quality of life

case studies