Endoscopic reintervention after unilateral metal stent deployment for MHBO using SIS method

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Oncology

Background:

• Malignant hilar biliary obstruction (MHBO) is often treated with endoscopic biliary drainage.
• Recurrent biliary obstruction (RBO) is common after unilateral metal stent placement.
• Endoscopic reintervention for RBO, especially contralateral drainage, can be challenging.

Purpose of the Study:

• To evaluate the safety and feasibility of the stent-in-stent (SIS) method for endoscopic reintervention.
• To manage recurrent biliary obstruction (RBO) in patients with malignant hilar biliary obstruction (MHBO).
• To assess outcomes after unilateral metal stent deployment.

Main Methods:

• Retrospective analysis of 11 patients with MHBO undergoing endoscopic reintervention using the SIS method.
• Data collected included technical/clinical success, procedure time, adverse events, stent patency, RBO, and survival.
• Patients had prior unilateral metal stent deployment for MHBO.

Main Results:

• Technical success was achieved in 9 out of 11 patients (82%), with all 9 achieving clinical success.
• Median procedure time was 73 minutes; adverse events included pancreatitis, cholangitis, and liver abscess.
• Recurrent biliary obstruction of the revisionary stent occurred in 67% of patients, with a median time to RBO of 95.5 days.

Conclusions:

• The stent-in-stent (SIS) method is a safe and technically feasible option for endoscopic reintervention.
• This approach addresses recurrent biliary obstruction in malignant hilar biliary obstruction patients post-unilateral metal stent.
• Further research may optimize outcomes for this challenging patient group.