Managing Occluded Uncovered Self-expanding Metal Stents in Patients with Malignant Hilar Biliary Obstruction: A Retrospective Cohort Study.

Abstract

Background and aims: The implantation of uncovered self-expanding metal stents (UCSEMS) is an established method for the palliative treatment of malignant hilar biliary obstruction (MHBO). However, with advances in chemotherapy extending patient survival, individuals treated primarily with UCSEMS increasingly encounter overgrowth of the tumour in the stent lumen and occlusion. In this study, we aimed to compare various methods of managing occluded UCSEMS.

Methods: We analyzed a cohort of 49 patients with malignant hilar biliary obstruction who were treated with UCSEMS implantation as first-line endoscopic treatment. We evaluated their follow-up data, recorded complications, and assessed the methods used to manage occluded stents: balloon cleaning, plastic stent in stent implantation, UCSEMS stent in stent implantation, fully covered self-expandable metal stent (FCSEMS) stent in stent implantation and radiofrequency ablation (RFA).

Results: Technical and clinical success rates of the reinterventions were 91.2% and 61.4%, respectively. Depending on the type of revisionary drainage method used, clinical success rates were as follows: 50% for balloon cleaning only, 66% for plastic stent placement, 68% for FCSEMS stent placement, 80% for RFA with simultaneous plastic stent placement, and 80% for UCSEMS stent placement (p=0.366). The mean time to the second reintervention (second ERCP after UCSEMS placement) was 238, 201, 264, 78, and 205 days, respectively (p=0.4999). The mean interval time for all reinterventions was 48, 75, 71, 66, and 95 days, respectively (p=0.0326).

Conclusions: All techniques demonstrated high technical feasibility. While UCSEMS re-stenting and RFA with plastic stents showed promising trends in clinical success and stent patency, definitive conclusions about superiority cannot be drawn. Further multicentre prospective studies are needed to validate these findings.