BACKGROUND AND AIMS To prevent stent migration, transpapillary stent placement has been recommended for the endoscopic treatment of malignant hilar biliary stricture. However, recent studies have suggested that placement above the papilla achieves better results, because it is believed to prevent reflux and prolong stent patency. The aim of this study was to compare the efficacy and safety aspects of transpapillary and suprapapillary stent placement. In addition, the success rates of stent revision were evaluated. MATERIALS AND METHODS The medical records of 73 patients with hilar cholangiocarcinoma who underwent endoscopic metal stent insertion between January 2005 and December 2015 were retrospectively reviewed. Patients were assigned by stent location to a suprapapillary (S group; N = 44) or a transpapillary (T group; N = 29) cohort. Clinical outcomes, stent patency, adverse events, and revision success rates were compared between the two study groups. RESULTS Patency periods were similar in the two groups (S; 140 vs. T; 157 days; P = 0.732). Rates of stent obstruction in the S and T groups were 63.4% and 55.2%, respectively (P = 0.470). An adverse event occurred in 15 (20.5%) of total study subjects, with no significant intergroup difference. The endoscopic revision success rate was significantly higher in the T group (P = 0.01), and the time required for revision tended to be shorter in the T group. CONCLUSIONS The effectiveness and safety of suprapapillary and transpapillary stent insertion were found to be similar, but the success rate of endoscopic revision was significantly higher for the T group. Therefore, we recommend that transpapillary stent placement be considered for patients with hilar cholangiocarcinoma and biliary obstruction.

中文翻译：

---

不可切除胆管癌合并胆道梗阻的上乳头和经乳头支架置入的临床结果比较。

背景与目的为了防止支架迁移，已建议经乳头内支架置入术用于内镜治疗恶性肝门胆管狭窄。但是，最近的研究表明，放置在乳头上方可获得更好的效果，因为据信它可以防止回流并延长支架的通畅性。本研究的目的是比较经乳头和乳头上支架置入的有效性和安全性。此外，评估了支架翻修的成功率。材料与方法回顾性分析了2005年1月至2015年12月间接受内镜金属支架置入术的73例肝门胆管癌患者的病历。按支架位置将患者分配至乳头上（S组； N = 44）或经乳头（T组； N = 29）队列。比较了两个研究组的临床结果，支架通畅性，不良事件和翻修成功率。结果两组的通畅期相似（S； 140 vs. T； 157天； P = 0.732）。S组和T组的支架阻塞率分别为63.4％和55.2％（P = 0.470）。共有15名（20.5％）研究对象发生了不良事件，组间无显着差异。T组的内镜翻修成功率显着更高（P = 0.01），T组的翻修所需时间往往较短。结论发现上乳头和经乳头支架置入的有效性和安全性相似，但T组的内镜翻修成功率明显更高。因此，