BACKGROUND In patients with unresectable hilar malignant biliary obstruction (MBO), bilateral metal stent placement is recommended. However, treatment selection between partially stent-in-stent (SIS) and side-by-side (SBS) methods is still controversial. STUDY Clinical outcomes of bilateral metal stent placement by SBS and SIS methods for hilar MBO were retrospectively studied in four Japanese centers. While large-cell-type uncovered metal stents were placed above the papilla in SIS, braided-type uncovered metal stents were placed across the papilla in SBS. RESULTS A total of 64 patients with hilar MBO (40 SIS and 24 SBS) were included in the analysis. Technical success rate was 100% in SIS and 96% in SBS. Functional success rate was 93% in SIS and 96% in SBS. Early adverse event rates were higher in SBS (46%) than in SIS (23%), though not statistically significant (P = 0.09). Post-procedure pancreatitis was exclusively observed in SBS group (29%). Recurrent biliary obstruction rates were 48% and 43%, and the median time to recurrent biliary obstruction was 169 and 205 days in SIS and SBS, respectively. CONCLUSIONS Other than a trend to higher adverse event rates including post-procedure pancreatitis in SBS, clinical outcomes of SIS and SBS methods were comparable in patients with unresectable hilar MBO.

中文翻译：

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肝门恶性胆道梗阻并排置入支架和支架置入支架的回顾性比较研究。

背景技术在无法切除的肺门恶性胆道梗阻（MBO）患者中，建议放置双侧金属支架。然而，在部分支架置入术（SIS）和并排（SBS）方法之间的治疗选择仍存在争议。研究在日本的四个中心对SBS和SIS方法双侧金属支架置入肝门MBO的临床结局进行了回顾性研究。在SIS中，将大细胞类型的未覆盖金属支架放置在乳头上方，而在SBS中将编织型的未覆盖金属支架放置在乳头上。结果本研究共纳入64例肺门MBO患者（40 SIS和24 SBS）。SIS的技术成功率为100％，SBS的技术成功率为96％。SIS的功能成功率是93％，SBS的功能成功率是96％。SBS（46％）的早期不良事件发生率高于SIS（23％）的早期不良事件发生率，尽管没有统计学意义（P = 0.09）。SBS组仅观察到术后胰腺炎（29％）。SIS和SBS的胆道梗阻复发率分别为48％和43％，中位复发胆道梗阻时间分别为169天和205天。结论除了发生SBS的术后不良事件发生率升高（包括术后胰腺炎）的趋势外，SIS和SBS方法的临床结果在不可切除的肺门MBO患者中具有可比性。