Evaluation of Useful Stent Selection in Unresectable Malignant Hilar Biliary Obstruction with a Unilateral Drainage...

Bilateral intraductal plastic stent (IS) placement is preferred for unresectable malignant hilar biliary obstruction (MHBO) owing to its stent patency and removability. However, certain clinical and technical conditions permit only unilateral drainage even for unresectable MHBO. A useful stent selection in such cases remains unclear.

Among 360 retrospective patients with MHBO, 118 underwent unilateral drainage with an across-papillary plastic stent (PS), IS, or a self-expandable metallic stent (SEMS). Outcomes were compared based on clinical success, adverse events (AEs), recurrent biliary obstruction (RBO), time to RBO (TRBO), and reintervention, using propensity score matching (PSM) analysis.

PSM identified 23 patients in each group for comparison. The RBO occurrence rates and median TRBO were 83%, 65%, and 48% (P = 0.054), and 44-days, 130-days, and 231-days in the PS, IS, and SEMS groups (P < 0.01), respectively. Post hoc tests showed that TRBO was significantly shorter in the PS group than in the IS (P = 0.04) and SEMS (P < 0.01) groups. In multivariate analysis, PS was a significant TRBO-related factor (hazard ratio 2.56, P < 0.01). There were no significant differences in the technical success rates, clinical success rates, procedure times, AEs, or TRBO after reintervention in the PS, IS, and SEMS groups.

Unilateral IS has longer stent patency than PS, better removability, and a higher technical success rate of reintervention than SEMS. IS may be a good option when only a unilateral drainage approach is available in patients with unresectable MHBO.

UMIN000057659.