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Updated: Mar 1, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Soft surface irregularity of malignant perihilar biliary strictures in cholangiography as a risk factor for early
Yoshihide Kanno1, Kei Ito1, Shinsuke Koshita1
1Sendai City Medical Center, Sendai, Miyagi, Japan.
Background:
Multiple metal stents (multi-MS) in the perihilar bile duct often develop dysfunction in an unexpectedly short period.
Aims:
This study is aimed to identify the risk factors for shorter patency of multi-MS.
Methods:
Of 97 patients who underwent multi-MS placement, 68 patients were followed-up for >28 days were retrospectively analyzed. Univariate analyses with the log-rank test was performed on 20 factors, including two newly defined classifications of cholangiography: the R classification, which classifies the rough image (localized type [R1] or spreading type [R2]); and the S classification, which classifies the surface texture (soft irregularity [S1], solid irregularity [S2], or smooth [S3]).
Results:
Stent dysfunction occurred in 36 patients (53%) (median time, 209 days). Type S1 was a significant risk factor for short stent patency (median, 100 days in S1 [n=18]; 231 in S2 [n=38]; 356 in S3 [n=12], p<0.0001). On multivariate analysis, type S1 was again the only independent factor among the six factors (HR 4.8, p<0.001).
Conclusion:
Soft surface irregularity of the perihilar malignancy in cholangiography was found to be a significant risk factor for a shorter time to dysfunction of multi-MS.
Insights
Soft surface irregularity on cholangiography is a key risk factor for early dysfunction of multiple metal stents (multi-MS) in the perihilar bile duct. This finding helps predict and potentially prevent stent failure.
Area of Science:
- Gastroenterology
- Interventional Radiology
- Biliary Interventions
Background:
- Multiple metal stents (multi-MS) placed in the perihilar bile duct are prone to premature dysfunction.
- Identifying factors contributing to stent patency is crucial for patient outcomes.
Purpose of the Study:
- To determine the risk factors associated with reduced patency of multi-MS in the perihilar bile duct.
- To investigate the impact of cholangiographic classifications on stent longevity.
Main Methods:
- Retrospective analysis of 68 patients who underwent multi-MS placement and were followed for over 28 days.
- Evaluation of 20 potential risk factors, including novel R (roughness) and S (surface texture) classifications from cholangiography.
- Log-rank test and multivariate analysis were employed to identify significant predictors of stent dysfunction.
Main Results:
- Stent dysfunction was observed in 53% of patients, with a median time to dysfunction of 209 days.
- Soft surface irregularity (S1 classification) was identified as a significant risk factor for shorter stent patency (median 100 days).
- Multivariate analysis confirmed S1 as the sole independent predictor of early stent dysfunction (Hazard Ratio 4.8, p<0.001).
Conclusions:
- Soft surface irregularity of perihilar malignancy on cholangiography is a significant risk factor for premature dysfunction of multi-MS.
- The S classification provides valuable prognostic information regarding the patency of biliary metal stents.
- These findings may aid in patient selection and management strategies for biliary interventions.
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