- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01141088
Two Bilateral Metal Stenting in Hilar Malignancy
December 15, 2017 updated by: Tae Hoon Lee, Soon Chun Hyang University
Clinical Outcomes of Endoscopic Bilateral Stent-in-stent Placement Versus Side-by-side Method With Newly Designed Metallic Stent for Malignant Hilar Biliary
The overall median survival of nonresectable malignant hilar obstruction in most series has been less than 6 months.
Most patients with malignant hilar obstruction present with advanced disease, making allative endoscopic drainage the principal therapeutic option.
However, the optimal endoscopic management strategy is contentious.
In malignant hilar obstruction, exclusively endoscopic placement of bilateral metal stents has been considered very difficult and complex, and it may require multiple procedures, with an increased risk of complications and mortality.
To overcome this difficulty and strategize plan of management, the investigators evaluated the technical and clinical efficacy of endoscopic bilateral placement of newly designed stents, Y-configuration, followed by side-by-side insertion in failure of stent-in-stent method for the management of malignant hilar obstruction.
Study Overview
Status
Unknown
Intervention / Treatment
Detailed Description
- Stent-in-stent (SIS) placement Following negotiation of both intrahepatic bile ducts (IHD) by two guidewires, inserted 1st stent to left IHD side. The central portion of the 1st stent was crossed over the right-side guide wire to access the contralateral ductal system across the central cross-wired portion using the right-side guide wire as a target. After deployment of the 1st stent across the hilar stricture, the remaining guide wire across the 1st stent was carefully withdrawn using an ERCP catheter without pulling it back completely. Then that guidewie was inserted under fluoroscopic guidance into the undrained right IHD through the central portion of the 1st stent. The 2nd cross-wired stent was then introduced over a guidewire through the central open mesh and then was deployed into the right IHD, so that the central portion of the 2nd stent overlapped the central portion of the 1st stent, forming a Y-shape. If selective insertion of a guide wire into the left IHD was difficult at first, the guidewire and the 1st stent were inserted into the right IHD first and then attempts were made to insert the guide wire and a stent into the left IHD. If contralateral guide wire cannulation failed after the 1st stent placement, the stricture was dilated up to 4 or 6 mm using a balloon catheter (Hurricane biliary balloon dilatation catheter; Boston Scientific) over the guide wire. Alternatively, a second intervention for contralateral stent placement was allowed 2-3 days after expansion of the 1st endoscopic stent.
- Side-by-side (SBS) placement Bilateral SBS stent placement was performed as follows. The stricture was first negotiated by inserting a guidewire into both IHD using the same method. Following the introduction of these two guidewires, the first stent was pushed and deployed into the left hepatic duct as possible, and then subsequently the second stent was pushed and deployed into the right hepatic duct, using the same method. During the deployment of the first stent, the second stent was preloaded on a guidewire to facilitate the bilateral SBS stent placement. Endoscopic dilatation of stricture before deployment of stents has not been routinely performed in primary procedures. In tight stricture during a guidewire manipulation, pneumatic biliary balloon dilation prior to insertion of first stent was performed. All stents were positioned above the level of the papilla, with their distal ends at the same level as possible. The diameter of the stent used in each case (8 or 10 mm) depended on the maximum diameter of the common bile duct (CBD).
Study Type
Interventional
Enrollment (Anticipated)
80
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Jong Ho Moon, MD, PhD
- Phone Number: +82-32-621-5083
- Email: jhmoon@schbc.ac.kr
Study Locations
-
-
-
Bucheon, Korea, Republic of, 420-767
- Recruiting
- Soon Chun Hyang University College of Medicine, Bucheon Hospital
-
Contact:
- Jong Ho Moon, MD, PhD
- Phone Number: +82-32-621-5083
- Email: jhmoon@schbc.ac.kr
-
Cheonan, Korea, Republic of, 330-721
- Recruiting
- Soon Chun Hyang University College of Medicine, Cheonan Hospital
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Patient over 18 years old
- patient with malignant hilar obstruction
Exclusion Criteria:
- refuse to participate in this study
- refuse to provide informed consent
- Karnofsky score < 60%
- physically unfit for endoscopic procedure
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Bilateral stent-in-stent insertion
The passage of the bilateral metal stent across the stricture, stent-in-stent method.
|
Following negotiation of both IHD by two guidewires, inserted 1st stent to left IHD side.
After deployment of the 1st stent across the hilar stricture, the remaining guide wire across the 1st stent was carefully withdrawn using an ERCP catheter without pulling it back completely.
Then that guidewie was inserted under fluoroscopic guidance into the undrained right IHD through the central portion of the 1st stent.
The 2nd cross-wired stent was then introduced over a guidewire through the central open mesh and then was deployed into the right IHD, so that the central portion of the 2nd stent overlapped the central portion of the 1st stent, forming a Y-shape.
Other Names:
Following the introduction of two guidewires, the first stent was pushed and deployed into the left hepatic duct as possible, and then subsequently the second stent was pushed and deployed into the right hepatic duct, using the same method.
In tight stricture during a guidewire manipulation, pneumatic biliary balloon dilation prior to insertion of first stent was performed.
All stents were positioned above the level of the papilla, with their distal ends at the same level as possible.
The diameter of the stent used in each case (8 or 10 mm) depended on the maximum diameter of the common bile duct (CBD).
Other Names:
|
Active Comparator: Bilateral side-by-side insertion
The passage of the bilateral metal stent across the stricture, side-by-side method.
|
Following negotiation of both IHD by two guidewires, inserted 1st stent to left IHD side.
After deployment of the 1st stent across the hilar stricture, the remaining guide wire across the 1st stent was carefully withdrawn using an ERCP catheter without pulling it back completely.
Then that guidewie was inserted under fluoroscopic guidance into the undrained right IHD through the central portion of the 1st stent.
The 2nd cross-wired stent was then introduced over a guidewire through the central open mesh and then was deployed into the right IHD, so that the central portion of the 2nd stent overlapped the central portion of the 1st stent, forming a Y-shape.
Other Names:
Following the introduction of two guidewires, the first stent was pushed and deployed into the left hepatic duct as possible, and then subsequently the second stent was pushed and deployed into the right hepatic duct, using the same method.
In tight stricture during a guidewire manipulation, pneumatic biliary balloon dilation prior to insertion of first stent was performed.
All stents were positioned above the level of the papilla, with their distal ends at the same level as possible.
The diameter of the stent used in each case (8 or 10 mm) depended on the maximum diameter of the common bile duct (CBD).
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Technical success
Time Frame: within 24 hr
|
Passage of the double stent across the stricture,along with flow of contrast medium and/or bile through the stent. Adequate expansion: 70% of maximal expanded diameter was dilated within 24 hr. |
within 24 hr
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Early complications
Time Frame: within 30 days after stent insertion
|
Early complications such as pancreatitis, cholecystitis, cholangitis, jaundice, or external or internal stent migration within 30 days after stent insertion.
|
within 30 days after stent insertion
|
Late complications
Time Frame: after 30 days following stent insertion
|
Late complications were defines as complications such as pancreatitis, cholecystitis, cholangitis, jaundice, or stent migration after 30 days following stent insertion.
|
after 30 days following stent insertion
|
Median stent patency
Time Frame: up to 1 year, from stent insertion to the occlusion of the stent
|
up to 1 year, from stent insertion to the occlusion of the stent
|
|
Median survival
Time Frame: 1 year, from stent insertion to the death of the patient
|
1 year, from stent insertion to the death of the patient
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Jong Ho Moon, MD, PhD, Soon Chun Hyang University College of Medicine, Bucheon Hospital, Bucheon, South Korea
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
April 1, 2016
Primary Completion (Anticipated)
March 30, 2018
Study Completion (Anticipated)
September 30, 2018
Study Registration Dates
First Submitted
June 8, 2010
First Submitted That Met QC Criteria
June 9, 2010
First Posted (Estimate)
June 10, 2010
Study Record Updates
Last Update Posted (Actual)
December 19, 2017
Last Update Submitted That Met QC Criteria
December 15, 2017
Last Verified
December 1, 2017
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- SCH-2010-02
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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