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Clinical Outcomes of Inside Stents and Conventional Plastic Stents as Bridge-to-Surgery Options for Malignant Hilar Biliary Obstruction

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Abstract

Background

The appropriate method of preoperative endoscopic biliary drainage (EBD) for cholangiocarcinoma with hilar biliary obstruction remains controversial. The inside-stent technique is a method of placing plastic stents entirely inside the bile duct. Several studies of patients with unresectable stage have reported longer stent patency compared with conventional endoscopic biliary stenting (EBS). Inside-stent techniques have been introduced as a bridge-to-surgery option and as an alternative to conventional EBS.

Aims

We aimed to evaluate the clinical outcomes of inside stent use and conventional EBS.

Methods

During this retrospective multicenter study, we reviewed consecutive patients with cholangiocarcinoma who underwent radical surgery after conventional EBS or inside-stent insertion. Adverse event (AE) rates after EBD and post-surgical AEs were compared. A multivariable analysis was performed to identify factors affecting cholangitis after EBD.

Results

Conventional EBS and inside-stent procedures were performed for 56 and 73 patients, respectively. Patient backgrounds were similar between groups, except for percutaneous transhepatic portal vein embolization. The waiting time before surgery was similar between groups (28.5 days vs. 30 days). There were no significant differences in the cholangitis rate (21.4% vs. 26.0%; P = 0.68) and all AEs (25.0% vs. 30.1%; P = 0.56) between groups. The post-surgical AE rate was similar between the groups. The multivariable analysis found that preprocedural cholangitis was a risk factor for cholangitis after EBD (odds ratio: 5.67; 95% confidence interval: 1.61–19.9).

Conclusions

The outcomes of inside-stent techniques and conventional EBS for the management of preoperative EBD are comparable for patients with cholangiocarcinoma.

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Acknowledgments

The authors gratefully acknowledge Dr. Junichi Kaneko, Dr. Junya Sato, Dr. Tatsunori Satoh, and all the members of the Division of Endoscopy at the Shizuoka Cancer Center for their assistance in this study.

Funding

This study did not receive any funding.

Author information

Authors and Affiliations

  1. Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan

    Hirotoshi Ishiwatari

  2. Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan

    Takanori Kawabata

  3. Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan

    Hiroki Kawashima & Hiroshi Mori

  4. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Yousuke Nakai & Kensaku Noguchi

  5. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan

    Shin Miura & Atsushi Masamune

  6. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan

    Hironari Kato & Yuki Fujii

  7. Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

    Hideyuki Shiomi

  8. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Nao Fujimori

  9. Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University (Osaka Medical College), Osaka, Japan

    Takeshi Ogura

  10. Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Otsu, Japan

    Osamu Inatomi

  11. Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Kensuke Kubota

  12. Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan

    Toshio Fujisawa & Hiroyuki Isayama

  13. Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan

    Mamoru Takenaka

  14. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan

    Teiichi Sugiura

  15. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Noboru Ideno & Tomoki Nakafusa

  16. Division of Gastroenterology and Hepato-Biliary-Pancreatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan

    Hideyuki Shiomi

  17. Division of Hepato-Biliary-Pancreatic Medicine, Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Naoki Sasahira

Authors
  1. Hirotoshi Ishiwatari
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  2. Takanori Kawabata
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  9. Takeshi Ogura
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  14. Hiroshi Mori
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  15. Kensaku Noguchi
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  16. Yuki Fujii
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  18. Noboru Ideno
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  19. Tomoki Nakafusa
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  20. Atsushi Masamune
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  21. Hiroyuki Isayama
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  22. Naoki Sasahira
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Corresponding author

Correspondence to Hirotoshi Ishiwatari.

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Conflict of interest

H. Ishiwatari received a research grant from the Century Medical Corporation and Medico’s Hirata Inc. Y. Nakai received a research grant and a speaker’s fee from Boston Scientific, Japan. H. Isayama received research grants, scholarship contributions, and lecture fees from the Boston Scientific Corporation and Gadelius Medical K.K. T. Fujisawa received a lecture fee from the Boston Scientific Corporation.

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Ishiwatari, H., Kawabata, T., Kawashima, H. et al. Clinical Outcomes of Inside Stents and Conventional Plastic Stents as Bridge-to-Surgery Options for Malignant Hilar Biliary Obstruction. Dig Dis Sci 68, 1139–1147 (2023). https://doi.org/10.1007/s10620-022-07718-y

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