Suprapapillary Stent-By-Stent Deployment With Slim-Fully Covered Versus Uncovered Metal Stents for Malignant Hilar Biliary Obstruction: A Multicenter Comparative Study (With Video).

Abstract

Background: Bilateral uncovered metal stent (UMS) placement is recommended for unresectable malignant hilar biliary obstructions (MHBO). However, recent improvements in antitumor therapies and patient survival have led to an increasing number of patients outliving UMS patency, necessitating more frequent reinterventions. This study evaluated the efficacy of novel suprapapillary stent-by-stent (SBS) placement using slim fully covered metal stents (FCMS) and compared them with UMS.

Methods: A total of 254 patients were included. Technical and clinical success, adverse events (AEs) including recurrent biliary obstruction (RBO), and reintervention were compared between the FCMS and UMS groups. Propensity score matching was performed to adjust for between-group differences.

Results: Technical and clinical success rates and early and late AE rates were not significantly different between the groups. The FCMS group demonstrated a significantly lower RBO incidence rate (32.0% vs. 60.8%; p = 0.005) and a significantly longer time to RBO (median, NA vs. 204 days; p = 0.048). However, in the FCMS group, 4.0% of patients required stent removal because of suspected branch occlusion. The technical success rates of reintervention were 100% and 83.3% in the FCMS and UMS groups (p = 0.147), respectively. Compared to the UMS group, the FCMS group demonstrated a significantly shorter reintervention procedure time (median, 20 vs. 31 min; p = 0.005) and a significantly lower number of reinterventions (p = 0.029) and requirement for repeat reinterventions (p = 0.003).

Conclusions: Suprapapillary slim FCMS SBS placement may be a promising treatment option for patients with unresectable MHBO. However, early and unique events requiring stent removal should be carefully considered.