Abstract
Background
In patients with unresectable hilar malignant biliary obstruction (MBO), bilateral metal stent placement is recommended. However, treatment selection between partially stent-in-stent (SIS) and side-by-side (SBS) methods is still controversial.
Study
Clinical outcomes of bilateral metal stent placement by SBS and SIS methods for hilar MBO were retrospectively studied in four Japanese centers. While large-cell-type uncovered metal stents were placed above the papilla in SIS, braided-type uncovered metal stents were placed across the papilla in SBS.
Results
A total of 64 patients with hilar MBO (40 SIS and 24 SBS) were included in the analysis. Technical success rate was 100% in SIS and 96% in SBS. Functional success rate was 93% in SIS and 96% in SBS. Early adverse event rates were higher in SBS (46%) than in SIS (23%), though not statistically significant (P = 0.09). Post-procedure pancreatitis was exclusively observed in SBS group (29%). Recurrent biliary obstruction rates were 48% and 43%, and the median time to recurrent biliary obstruction was 169 and 205 days in SIS and SBS, respectively.
Conclusions
Other than a trend to higher adverse event rates including post-procedure pancreatitis in SBS, clinical outcomes of SIS and SBS methods were comparable in patients with unresectable hilar MBO.
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KI, TH, HI, and YN conceived and designed the study, analyzed and interpreted the data, and drafted the article. TS, RH, KS, TS, NT, SM, HK, YI, HY, SM, DA, DM, MT, and KK critically revised the article for important intellectual content. All authors contributed to the final approval of the article.
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Yousuke Nakai and Hiroyuki Isayama received research grant from Boston Scientific Japan. The other authors have no conflicts of interest to declare.
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Ishigaki, K., Hamada, T., Nakai, Y. et al. Retrospective Comparative Study of Side-by-Side and Stent-in-Stent Metal Stent Placement for Hilar Malignant Biliary Obstruction. Dig Dis Sci 65, 3710–3718 (2020). https://doi.org/10.1007/s10620-020-06155-z
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DOI: https://doi.org/10.1007/s10620-020-06155-z