Simultaneous Versus Sequential Side-by-Side Bilateral Metal Stent Placement for Malignant Hilar Biliary Obstructions

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Biliary Interventions

Background:

• Malignant hilar biliary obstructions (MHBOs) present technical challenges for endoscopic bilateral self-expandable metallic stent (SEMS) placement.
• Sequential placement of SEMS for MHBOs is particularly demanding, often requiring complex maneuvers.

Purpose of the Study:

• To evaluate the feasibility and efficacy of a simultaneous side-by-side (SBS) SEMS placement technique for MHBOs.
• To assess the utility of a novel 5.7-Fr ultra-thin delivery system for simultaneous SBS SEMS placement.

Main Methods:

• A retrospective study comparing sequential and simultaneous SBS SEMS placement in 34 patients with MHBOs between 2010 and 2016.
• Patients were divided into a sequential group (2010-2014) and a simultaneous group (2015-2016).
• Clinical outcomes, including technical success and procedure time, were compared between the two groups.

Main Results:

• The technical success rate was significantly higher in the simultaneous group (100%) compared to the sequential group (71%) (P = .045).
• The median procedure time was significantly shorter in the simultaneous group (22 minutes) versus the sequential group (52 minutes) (P = .017).
• No significant differences were observed in the time to recurrent biliary obstruction or adverse event rates between the groups.

Conclusions:

• Simultaneous SBS SEMS placement with the novel ultra-thin delivery system is a feasible and effective technique for MHBOs.
• This method demonstrates a higher technical success rate and reduced procedure time compared to sequential placement.
• The simultaneous approach may simplify bilateral stenting in the management of MHBOs.