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Published on: March 25, 2022
Percutaneous stent placement for malignant hilar biliary obstruction: a comparison between criss-cross and
C H Jeon1, C J Yoon1, N J Seong1
1Division of Vascular and Interventional Radiology, Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, South Korea.
Insights
The criss-cross configuration for biliary stent placement offers longer stent patency compared to the T-configuration technique in malignant hilar obstruction. While early clinical effectiveness is similar, criss-cross placement reduces the need for repeat interventions.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Oncology
Background:
- Malignant hilar biliary obstruction presents a significant challenge in patient management.
- Percutaneous stent placement is a common intervention for biliary drainage.
Purpose of the Study:
- To compare the clinical effectiveness of T-configured versus criss-cross configured percutaneous stent placement techniques.
- To evaluate stent patency, complications, and survival rates between the two configurations.
Main Methods:
- Retrospective study of 59 patients with malignant hilar obstruction undergoing percutaneous stent placement.
- Comparison of T-configured (33 patients) and criss-cross configured (26 patients) stent placements.
- Assessment of technical success, clinical success, complications, survival, and stent patency.
Main Results:
- Both techniques demonstrated high technical and clinical success rates.
- Criss-cross configuration showed significantly longer stent patency (median 330 days) compared to T-configuration (median 132 days).
- No major complications were reported; however, T-configuration occasionally required additional interventions for undrained sectors.
Conclusions:
- Percutaneous biliary stent placement with criss-cross configuration provides superior long-term stent patency.
- While early clinical outcomes are comparable, the criss-cross technique may reduce the need for re-intervention.
- Both configurations are viable options, but criss-cross placement is favored for extended patency in malignant hilar biliary obstruction.
Aim:
To compare the clinical effectiveness of percutaneous stent placement between T and criss-cross configuration techniques in patients with advanced malignant hilar biliary obstruction.
Materials And Methods:
Between January 2009 and December 2014, 59 patients who underwent percutaneous stent placement for malignant hilar obstruction were included in this retrospective study. T-configured stent placement (T group) was performed in 33 patients and criss-cross configured stent placement (criss-cross group) in 26 patients. Technical and clinical success, complications, patient survival, and stent patency were compared between the two groups.
Results:
Stent placement was technically successful in all patients of the two groups. Clinical success was achieved in 30 (90.9%) patients of T group and 25 (96.9%) of criss-cross group (p=0.62). Two patients in the T group (6.1%) required additional stent placement for internal drainage of undrained sector. There were no major complications. Median survival was not statistically different between the two groups (128 days in the T group versus 183 days in the criss-cross group; p=0.33). Stent occlusion occurred in 15 patients in the T group and seven patients in the criss-cross group. The stent patency of the criss-cross group (median 330 days) was longer than that of the T group (median 132 days; p=0.0007).
Conclusions:
Early clinical effectiveness is comparable between the two techniques; however, additional intervention is occasionally required for drainage of an undrained sector after T-configured stent placement. Stent placement with criss-cross configuration provides longer stent patency than T-configuration technique.
