Retrospective Comparison of Initial vs. Subsequent Simultaneous Side-by-Side Stenting with Uncovered Metal Stents during Endoscopic Retrograde Cholangiopancreatography for Unresectable Malignant Hilar Biliary Obstructions.

Background and aims: This study aimed to evaluate the efficacy and safety of transpapillary simultaneous side-by-side (SBS) stenting using uncovered self-expandable metal stents (UCSEMSs) at the initial endoscopic retrograde cholangiopancreatography (ERCP) for unresectable malignant hilar biliary obstruction (UMHBO).

Methods: A total of 67 patients with UMHBO who underwent simultaneous SBS stenting at our institution were retrospectively divided into two groups: the SBS stenting at the initial ERCP group (n=13) and the SBS stenting at the subsequent ERCP group (n=54). Clinical outcomes were compared between the groups.

Results: There were no significant differences between the SBS stenting at the initial ERCP group and the SBS stenting at the subsequent ERCP group in procedural time (median: 50 vs. 40 minutes, p=0.31), functional success rate (69.2% vs. 83.3%, p=0.25), adverse event rate (30.8% vs. 14.8%, p=0.18), recurrent biliary obstruction (RBO) rate (23.1% vs. 38.9%, p=0.29), technical success rate of re-intervention (100% vs. 90.5%, p=0.58), cumulative time to RBO (not reached vs. 252 days, p=0.80), or median overall survival (73 vs. 212 days, p=0.12).

Conclusions: Simultaneous SBS stenting using UCSEMSs at the initial ERCP is a safe and effective strategy for managing UMHBO, with outcomes comparable to those of SBS stenting performed at the subsequent ERCP.