Comparison of double-layer large-diameter and conventional small-diameter plastic stents for preoperative biliary drainage in resectable distal malignant biliary obstruction

Tokuhiro Matsubara,Shiro Hayashi,Kengo Matsumoto,Tsutomu Nishida,Hiromi Shimakoshi,Yoshito Tomimaru,Masami Inada,Masashi Yamamoto,Dai Nakamatsu,Kei Takahashi

doi:10.1038/s41598-020-70183-y

Tokuhiro Matsubara, Shiro Hayashi + Show 8 more

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https://doi.org/10.1038/s41598-020-70183-y

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Journal: Scientific Reports	Publication Date: Aug 6, 2020
Citations: 2	License type: open-access

Affiliation: Toyonaka Municipal Hospital, Osaka University

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The use of a plastic stent (PS) in resectable patients with distal malignant biliary obstruction (DMBO) is uncommon due to the high failure rate of this method. This study evaluated the efficacy and safety of a double-layer, large-diameter PS as a bridge to surgery compared with a conventional PS. This was a single-center retrospective cohort study. In total, 129 consecutive patients with DMBO underwent pancreaticoduodenectomy between January 2011 and March 2018. Fifty-five patients who preoperatively underwent plastic biliary drainage were enrolled. The patients were divided into two groups based on stent diameter: a large-diameter plastic stent (LPS) group and a small-diameter plastic stent (SPS) group. The primary endpoint was the stent patency period, and the secondary endpoint was the medical cost. Thirty-six patients received SPSs; 19 patients received LPSs. The patency rate until surgery was significantly higher in the LPS group than in the SPS group (89.5% vs. 41.7%, P = 0.0006). Multivariate analysis revealed that LPS use was significantly associated with sufficient stent patency. The total cost of LPS use was significantly lower than that of SPS use. LPSs had longer patency and reduced medical costs than SPSs. LPSs may be suitable for patients with DMBO who are scheduled to undergo surgery.

Highlights

The use of a plastic stent (PS) in resectable patients with distal malignant biliary obstruction (DMBO) is uncommon due to the high failure rate of this method
We found that double-layer large-diameter PSs have significantly longer patency than do conventional small-sized PSs
A 10-Fr double-layer stent (DLS) may be used as an alternative for biliary drainage in the setting of upfront surgery for DMBO because it can maintain stent patency for at least 1 month prior to surgery

Summary

Introduction

The use of a plastic stent (PS) in resectable patients with distal malignant biliary obstruction (DMBO) is uncommon due to the high failure rate of this method. Recent ESGE guidelines strongly recommend the endoscopic placement of a 10-mm-diameter self-expandable metallic stent (SEMS) for preoperative biliary drainage of MBO because SEMSs are associated with a lower rate of reintervention than is the use of a plastic stent (PS) and based on a meta-analysis, there is no difference in Scientific Reports | (2020) 10:13222. The Japanese guidelines for the management of biliary tract cancers recommend that preoperative biliary drainage is necessary for patients with jaundice and that endoscopic drainage is the most appropriate procedure due to the low risk of complications[5]. These guidelines do not specify a stent type or size[5]. Haapamaki et al reported that PSs do not differ from SEMSs with regard to stent dysfunction, decrease in bilirubin, or postoperative complications in a preoperative setting[6]

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