Abdominal Radiology

, Volume 42, Issue 11, pp 2745–2751 | Cite as

Unilateral versus bilateral stent insertion for malignant hilar biliary obstruction

  • Gang Chang
  • Feng-Fei Xia
  • Hong-Fu Li
  • Su Niu
  • Yuan-Shun XuEmail author



To determine the clinical efficiency and long-term outcomes between unilateral and bilateral stent insertion in patients with malignant hilar biliary obstruction.


From August 2012 to February 2016, 63 consecutive patients with malignant hilar biliary obstruction were treated with unilateral or bilateral stent insertion at our center. The bilateral stents were inserted using the side-by-side technique. The clinical efficiency and long-term outcomes were compared between the two groups.


Unilateral and bilateral stent insertions were successfully performed in 31 of 33 and 27 of 30 patients, respectively (P = 0.912). No procedure-related complication occurred. Clinical success was achieved in 29 of 31 patients in the unilateral stent group and in 26 of 27 patients in the bilateral stent group (P = 0.637). During the follow-up, re-obstruction of stent occurred in five patients in the unilateral stent group and in three patients in the bilateral stent group (P = 0.58). The significant differences were not observed in the stent patency time (368 vs. 387 days, P = 0.685) and survival (200 vs. 198 days, P = 0.751) between two groups. Based on the univariate and multivariate analyses, the independent risk factors for decreasing the survival time included higher Eastern Cooperative Oncology Group performance status (P = 0.018), higher alanine aminotransferase level (P = 0.009), and absence of anticancer treatment after stent insertion (P = 0.002).


Compared to bilateral stent insertion for malignant hilar biliary obstruction, unilateral stent insertion can provide comparable clinical efficiency and long-term outcomes.


Unilateral stent insertion Bilateral stent insertion Hilar biliary obstruction 


Compliance with ethical standards


No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Singhal D, van Gulik TM, Gouma DJ (2005) Palliative management of hilar cholangio carcinoma. Surg Oncol 14:59–74CrossRefPubMedGoogle Scholar
  2. 2.
    Jang SI, Lee DK (2015) Update on pancreatobiliary stents: stent placement in advanced hilar tumors. Clin Endosc 48:201–208CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Di Mitri R, Mocciaro F (2014) Y-shaped bilateral self-expandable metallic stent placement for malignant hilar biliary obstruction: data from a referral center for palliative care. Sci World J 2014:151502Google Scholar
  4. 4.
    Li M, Bai M, Qi X, et al. (2015) Percutaneous transhepatic biliary metal stent for malignant hilar obstruction: results and predictive factors for efficacy in 159 patients from a single center. Cardiovasc Intervent Radiol 38:709–721CrossRefPubMedGoogle Scholar
  5. 5.
    Li M, Li K, Qi X, et al. (2016) Percutaneous transhepatic biliary stent implantation for obstructive jaundice of perihilar cholangiocarcinoma: a prospective study on predictors of stent patency and survival in 92 patients. J Vasc Interv Radiol 27:1047–1055CrossRefPubMedGoogle Scholar
  6. 6.
    Yun JH, Jung GS, Park JG, et al. (2016) Malignant hilar biliary obstruction: treatment by means of placement of a newly designed Y-shaped branched covered stent. Cardiovasc Intervent Radiol 39:582–590CrossRefPubMedGoogle Scholar
  7. 7.
    Jiao D, Huang K, Zhu M, et al. (2017) Placement of a newly designed Y-configured bilateral self expanding metallic stent for hilar biliary obstruction: a pilot study. Dig Dis Sci 62:253–263CrossRefPubMedGoogle Scholar
  8. 8.
    Son RC, Gwon DI, Ko HK, et al. (2015) Percutaneous unilateral biliary metallic stent placement in patients with malignant obstruction of the biliary hila and contralateral portal vein steno-occlusion. Korean J Radiol 16:586–592CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Yi R, Gwon DI, Ko GY, et al. (2012) Percutaneous unilateral placement of biliary covered metallic stent in patients with malignant hilar biliary obstruction and contralateral portal vein occlusion. Acta Radiol 53:742–749CrossRefPubMedGoogle Scholar
  10. 10.
    Yasuda I, Mukai T, Moriwaki H, et al. (2013) Unilateral versus bilateral endoscopic biliary stenting for malignant hilar biliary strictures. Dig Endosc 25:81–85CrossRefPubMedGoogle Scholar
  11. 11.
    Niu S, Cheng L, Qiao Y, et al. (2016) Combined stent insertion and high-intensity focused ultrasound ablation for patients with malignant obstructive jaundice. Surg Laparosc Endosc Percutan Tech 26:488–492CrossRefPubMedGoogle Scholar
  12. 12.
    Kitano M, Yamashita Y, Tanaka K, et al. (2013) Covered self-expandable metal stents with an anti-migration system improve patency duration without increased complications compared with uncovered stents for distal biliary obstruction caused by pancreatic carcinoma: a randomized multicenter trial. Am J Gastroenterol 108:1713–1722CrossRefPubMedGoogle Scholar
  13. 13.
    Telford JJ, Carr-Locke DL, Baron TH, et al. (2010) A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction. Gastrointest Endosc 72:907–914CrossRefPubMedGoogle Scholar
  14. 14.
    Li TF, Chen C, Han XW, et al. (2014) Clinical efficacy of metallic biliary stents combined with different anti-cancer treatments in the management of bile duct cancer. Hepatogastroenterology 61:22–26PubMedGoogle Scholar
  15. 15.
    Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T, et al. (2013) Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol 28:593–607CrossRefPubMedGoogle Scholar
  16. 16.
    Sawas T, Al Halabi S, Parsi MA, et al. (2015) Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis. Gastrointest Endosc 82:e257CrossRefGoogle Scholar
  17. 17.
    Iwano H, Ryozawa S, Ishigaki N, et al. (2011) Unilateral versus bilateral drainage using self-expandable metallic stent for unresectable hilar biliary obstruction. Dig Endosc 23:43–48CrossRefGoogle Scholar
  18. 18.
    Naitoh I, Ohara H, Nakazawa T, et al. (2009) Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction. J Gastroenterol Hepatol 24:552–557CrossRefPubMedGoogle Scholar
  19. 19.
    Naitoh I, Hayashi K, Nakazawa T, et al. (2012) Side-by-side versus stent-in-stent deployment in bilateral endoscopic metal stenting for malignant hilar biliary obstruction. Dig Dis Sci 57:3279–3285CrossRefPubMedGoogle Scholar
  20. 20.
    Law R, Baron TH (2013) Bilateral metal stents for hilar biliary obstruction using a 6Fr delivery system: outcomes following bilateral and side-by-side stent deployment. Dig Dis Sci 58:2667–2672CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Gang Chang
    • 1
  • Feng-Fei Xia
    • 1
  • Hong-Fu Li
    • 1
  • Su Niu
    • 2
  • Yuan-Shun Xu
    • 3
    Email author
  1. 1.Department of Interventional Vascular SurgeryBinzhou People’s HospitalBinzhouChina
  2. 2.Department of Interventional RadiologyXuzhou Central HospitalXuzhouChina
  3. 3.Department of RadiologyXuzhou Central HospitalXuzhouChina

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