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The role of stent placement above the papilla (inside-stent) as a bridging therapy for perihilar biliary malignancy: an initial experience

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Abstract

Purpose

Although endoscopic naso-biliary drainage (ENBD) is a popular preoperative biliary drainage (PBD) method for patients with perihilar biliary malignancy (PHBM), patient discomfort caused by the nasal tube remains a problem. This study aimed to analyze the safety and efficacy of PBD with the placement of a plastic stent above the papilla [inside-stent (IS)] as a bridging therapy.

Methods

The outcomes of 78 patients with potentially resectable PHBM, of whom 29 underwent IS placement and 49 underwent ENBD were evaluated.

Results

The stent-associated complication rates were not different between the two groups (7% in the IS group and 10% in the ENBD group, P = 0.621). Catheter dislocation occurred less frequently (0% vs. 22%, P = 0.016), and the median time to recurrent biliary obstruction was longer (not reached vs. 32 days, P = 0.039) in the IS group than in the ENBD group. Among the patients who underwent resection, their postoperative severe complication rates were not substantially different (26% vs. 25%, P = 0.923).

Conclusion

IS placement is a possible alternative to ENBD as a bridge to a definitive operation for patients with resectable PHBM and a prospective trial to prove its feasibility and safety is therefore warranted.

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Yu Takahashi, Yosuke Inoue, Yoshihiro Mise, Takafumi Sato, Yoshihiro Ono, Atsushi Oba, Akio Saiura & Hiromichi Ito

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

    Naoki Sasahira & Takashi Sasaki

  3. Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan

    Yoshihiro Mise & Akio Saiura

Authors
  1. Yu Takahashi
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  2. Naoki Sasahira
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  3. Takashi Sasaki
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  4. Yosuke Inoue
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  5. Yoshihiro Mise
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  6. Takafumi Sato
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Correspondence to Yu Takahashi.

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Takahashi, Y., Sasahira, N., Sasaki, T. et al. The role of stent placement above the papilla (inside-stent) as a bridging therapy for perihilar biliary malignancy: an initial experience. Surg Today 51, 1795–1804 (2021). https://doi.org/10.1007/s00595-021-02268-8

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  • DOI: https://doi.org/10.1007/s00595-021-02268-8

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