Endoscopic treatment of malignant hilar biliary obstruction: A retrospective cohort study

Endoscopic biliary drainage for malignant hilar biliary obstruction (MHBO) remains a highly complex endoscopic retrograde cholangiopancreatography (ERCP) procedure. Each case requires an individualized approach, with outcomes influenced by the expertise of the medical center and access to advanced endoscopic tools.

To compare different stent types and drainage strategies, including the use of adjunctive therapies, in patients with MHBO treated endoscopically.

We retrospectively analyzed 164 patients with MHBO (Bismuth types 3-4) who underwent exclusive endoscopic drainage. Patients were grouped by stent type-uncovered self-expandable metal stents (UCSEMS), bilateral plastic stents, or a mixed approach (fully covered self-expandable metal stents + plastic)-as well as by drainage strategy (unilateral/bilateral) and use of radiofrequency ablation (RFA) or chemotherapy.

Patients receiving UCSEMS had significantly longer overall survival compared to those with plastic stents or the mixed approach (P < 0.0001). Mean stent occlusion times were 80 days (bilateral plastic), 84.4 days (mixed approach), and 122.5 days (UCSEMS; P < 0.0001). The mean number of ERCP reinterventions was highest in the UCSEMS group (5.4) compared to bilateral plastic (2.5) and mixed approach group (4.5; P < 0.0001). Patients who received RFA or chemotherapy had significantly longer survival (P < 0.0001).

Bilateral UCSEMS stenting appears most effective for palliative treatment of MHBO. Adjunctive use of RFA and chemotherapy may further enhance survival, supporting a personalized, multidisciplinary approach.