Long slim versus conventional self-expandable metallic stent in bilateral endoscopic side-by-side deployment for unresectable malignant hilar biliary obstruction

Background and Aims

The goal of this study was to compare the advantages of long slim metal stents (LSMSs) versus conventional metal stents in bilateral endoscopic side-by-side (SBS) deployment for malignant hilar biliary obstruction (MHBO).

Methods

A total of 140 consecutive patients with MHBO treated by endoscopic bilateral SBS deployment at a high-volume tertiary referral center were analyzed retrospectively; this included 50 patients in the LSMS group and the other 90 patients in the conventional SBS group as control. Propensity score matching at a 1:2 ratio was used to reduce selection bias. The primary outcome was stent patency.

Results

After propensity score matching, no significant difference was observed in stent patency (267 vs 268 days; P = .923) or overall survival (225 vs 211 days; P = .883) between the 2 groups. The technical success rate was 100% in both groups, and the clinical success rate was 91.1% in the LSMS group and 92.9% in the control group (P = .735). Early and late adverse events were similar (24.4% vs 34.3%, P = .423; 42.2% vs 38.6%, P = .697); the procedure time and bilateral metal stenting time in the LSMS group were significantly shorter (41.0 minutes vs 57.5 minutes, P = .000; 19.0 minutes vs 28.5 minutes, P = .000). The success rate of endoscopic bilateral revisionary stent insertion in the LSMS group was also higher (100% vs 33.3%; P = .000).

Conclusions

Bilateral LSMS placement is a viable option for patients with MHBO. It includes advantages of less operative difficulty and easier future re-intervention over conventional SBS stenting.