Abstract
The ideal type of stent utilized at index endoscopic retrograde cholangiopancreatography (ERCP) in management of malignant hilar obstruction (MHO) remains unclear. We aimed to determine the ideal stent choice in patients with MHO. In this retrospective study, patients with unresectable MHO were separated into the plastic stent (PS) group and the self-expandable metal stent (SEMS) group. The primary outcome was the risk and rate of rescue percutaneous transhepatic biliary drainage (PTBD). The secondary outcomes were the progression-free survival, the overall survival and the PTBD-free period (days). Thirty-six patients in the PS group and 38 patients in the SEMS group were enrolled. The risk for PTBD was higher in SEMS group (HR = 2.205, 95% C.I. 0.977–4.977, P = 0.057). The rate of PTBD was significantly lower in the PS group. (22.2% vs 50.0%, P = 0.017) There were no differences in overall survival and progression-free survival (410 and 269 in the PS group, 395 and 266 in the SEMS group, P = 0.663 and P = 0.757). The PTBD-free period was significantly longer in the PS group. (836.43 vs 586.40, P = 0.039) Although comparable in clinical efficacy, utilization of PS at index ERCP may reduce patient’s discomfort by avoiding PTBD and prolonging PTBD-free period in patients with MHO.
Highlights
Patients with malignant hilar obstruction (MHO) from biliary tract cancer have poor prognosis as only 20–30% of the patients are amenable for surgical resection[1,2]
As recent advancements in palliative therapies have resulted in improved longevity for the patients with unresectable MHO, it is logical to assume that the frequency of endoscopic or percutaneous revision of restenosis has increased in recent years[11,12,13,14,15]
We observed in our practice a steady increase in number of endoscopic retrograde biliary drainage (ERBD) revision among the patients with unresectable MHO as their length of survival has seen steady rise in recent years
Summary
Patients with malignant hilar obstruction (MHO) from biliary tract cancer have poor prognosis as only 20–30% of the patients are amenable for surgical resection[1,2]. There may be no difference in the success rates of primary revision between PS and SEMS after re-occlusion of index ERBD, repeated revision with SEMS is often more difficult than repeated PS replacement and will eventually rely on percutaneous transhepatic biliary drainage (PTBD) more frequently than revision with PS. We aimed to compare clinical efficacy, survival and patency durations and the need for revision due to re-occlusion after of initial ERBD based on the type of stent (PS or SEMS) used at the time of index ERBD
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