[Comparative analysis of side-by-side antegrade stenting and Y-biliary stenting for malignant biliary stricture]

In the time period from 2009 to 2017 in Botkin Hospital (Moscow) bilateral biliary stenting was performed in 43 patients with malignant common hepatic duct stricture. Patients were divided into 2 statistically homogeneous groups: 'side-by-side' stenting in 28 patients and percutaneous 'Y'-biliary stent placement in 15 patients. The causes of malignant obstruction were as follows: in the 1^st group 13 (46.4%) patients with extrahepatic cholangiocarcinoma (46.4%), 8 (28.6%) patients with intrahepatic cholangiocarcinoma, 4 (14.3%) patients with gallbladder cancer, 3 (10.7%) patients with metastatic cancer. In the 2^nd group 6 (40%) patients with extrahepatic cholangiocarcinoma, 4 (26.6%) patients with intrahepatic cholangiocarcinoma, 2 (13.3%) patients with gallbladder cancer, 3 (20%) patients with metastatic cancer. Characteristics of patients: age - 1^st group 71.2±5.1 years, 2^nd group 74.3±5.5 years; sex - (m/f) 1^st group 18/10, 2^nd group 9/6; location of stricture - 1^st group Bismuth IIIa/IIIb 17/11, 2^nd group Bismuth IIIa/IIIb 11/4; mean level of bilirubin - 1^st group 284±8.2 μmol/l; 2^nd group 311±7.4 μmol/l. Technically all procedures were successful (100%). No complications and mortality associated with the procedure was recorded. Clinically significant results were achieved in 26 (92.8%) patients in Group 1 and in 13 (86.7%) patients in Group 2 (p=0.043). Following stenting procedures, 23 (82.1%) patients in Group 1 and 11 (68.8%) patients in the Group 2 had chemotherapy (p=0.047). 19 patients from the 1^st group and 10 patients from the 2^nd group died due to tumor progression of the underlying disease, other patients are under care of a physician. Median survival rate: 1^st group (12 patients - 50 days, 7 patients - 100 days, 9 patients are alive at the time of writing); 2^nd group (7 patients - 50 days, 4 patients - 100 days, 4 patients are alive at the time of writing). The results of this study showed that 6 (21.4%) patients from the 1^st group and 4 (26.7%) patients from the 2^nd group had biliary stent occlusion (p=0.041). The average period of stent function in the 1^st group was 78±4.5 days, and 63±4.8 days in the 2^nd group (p=0.036). Based on the obtained results, it is recommended to use the 'side-by-side' method of bilobar biliary stenting in patients with malignant common hepatic duct strictures.