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The evaluation of bilateral stenting using braided or laser-cut self-expandable metallic stent for malignant hilar biliary obstruction

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Abstract

Objectives

Bilateral self-expandable metallic stent (SEMS) placement for unresectable malignant hilar biliary obstruction (UMHBO) is an effective option for biliary drainage with long-term stent patency. Laser-cut and braided SEMS can be used for bilateral SEMS placement. This study aimed to clarify any differences in the clinical features and proper use of the laser-cut and braided SEMS placement using the stent-in-stent method for UMHBO.

Methods

In this study, 78 patients who underwent bilateral stent-in-stent SEMS placement for UMHBO were included. The patients were divided into the laser-cut (n = 33) and braided groups (n = 45). Both groups were compared for technical and clinical success, adverse events (AEs), time to recurrent biliary obstruction (TRBO), overall survival, and endoscopic reintervention (ERI).

Results

There were no significant differences in technical and clinical success rates (laser-cut vs. braided group, 97% vs. 95.6%, P = 1.0), AEs (21.2% vs. 15.6%. P = 0.56), median TRBO (242 days vs. 140 days, P = 0.36), and median overall survival (654 days vs. 675 days, P = 0.58). ERI was required in 15 patients in the laser-cut group and in 20 patients in the braided group. The technical and clinical success rates of ERI (60% vs. 85%) were not significantly different (P = 0.13); however, the median ERI procedure time was significantly longer in the laser-cut group (38 min) than in the braided group (22 min; P = 0.02).

Conclusion

No significant difference in initial SEMS placement was noted between the laser-cut and braided groups; however, the laser-cut group required a longer ERI procedure time than that required by the braided group. The use of braided SEMS may be a convenient option for ERI.

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Abbreviations

ABBS:

Angle between the bilateral self-expandable metallic stent

AE:

Adverse event

CT:

Computed tomography

ERI:

Endoscopic reintervention

ES:

Endoscopic sphincterotomy

IHBD:

Intrahepatic bile duct

IQR:

Interquartile range

OS:

Overall survival

RBO:

Recurrent biliary obstruction

SBS:

Side-by-side

SEMS:

Self-expandable metallic stent

SIS:

Stent-in-stent

TRBO:

Time to recurrent biliary obstruction

UHMBO:

Unresectable malignant hilar biliary obstruction

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Funding

This work was supported by JSPS KAKENHI (Grant Number JP23K14646).

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Authors and Affiliations

  1. Department of Gastroenterology, Gifu Municipal Hospital, 7-1 Kashimacho, Gifu City, Gifu, 500-8513, Japan

    Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Yosuke Ohashi, Shota Iwata, Yuhei Iwasa & Eiichi Tomita

  2. Department of Gastroenterological Endoscopy, Kanazawa Medical University, Kahoku, Ishikawa, Japan

    Tsuyoshi Mukai

  3. Department of Gastroenterology, Gifu Prefecture General Medical Center, Gifu City, Japan

    Kensaku Yoshida & Akinori Maruta

  4. First Department of Internal Medicine, Gifu University Hospital, Gifu City, Japan

    Ryuichi Tezuka, Hironao Ichikawa, Naoki Mita, Shinya Uemura, Takuji Iwashita & Masahito Shimizu

Authors
  1. Mitsuru Okuno
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  2. Keisuke Iwata
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  3. Tsuyoshi Mukai
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  4. Yosuke Ohashi
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  5. Shota Iwata
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  14. Eiichi Tomita
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  15. Masahito Shimizu
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Contributions

Conceptualization, methodology, formal analysis: MO, KI, TM. Investigation: MO, YO, SI, YI, KY, AM, RT, Hironao Ichikawa, NM, SU, Writing original draft preparation: MO. Writing review and editing: KI, TM. Supervision: TI, ET, MS.

Corresponding author

Correspondence to Mitsuru Okuno.

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Disclosures

Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Yosuke Ohashi, Shota Iwata, Yuhei Iwasa, Kensaku Yoshida, Akinori Maruta, Ryuichi Tezuka, Hironao Ichikawa, Naoki Mita, Shinya Uemura, Takuji Iwashita, Eiichi Tomita, and Masahito Shimizu have no conflicts of interest or financial ties to disclose.

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Okuno, M., Iwata, K., Mukai, T. et al. The evaluation of bilateral stenting using braided or laser-cut self-expandable metallic stent for malignant hilar biliary obstruction. Surg Endosc 37, 8489–8497 (2023). https://doi.org/10.1007/s00464-023-10457-4

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  • DOI: https://doi.org/10.1007/s00464-023-10457-4

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