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Retrospective Comparative Study of Side-by-Side and Stent-in-Stent Metal Stent Placement for Hilar Malignant Biliary Obstruction

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Abstract

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.

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Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan

    Kazunaga Ishigaki, Tsuyoshi Hamada, Yousuke Nakai, Hiroyuki Isayama, Tatsuya Sato, Ryunosuke Hakuta, Kei Saito, Tomotaka Saito, Naminatsu Takahara, Suguru Mizuno, Hirofumi Kogure, Minoru Tada & Kazuhiko Koike

  2. Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan

    Yousuke Nakai

  3. Department of Gastroenterology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Hiroyuki Isayama

  4. Department of Gastroenterology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan

    Yukiko Ito

  5. Department of Gastroenterology, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan

    Hiroshi Yagioka & Saburo Matsubara

  6. Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan

    Saburo Matsubara

  7. Department of Gastroenterology, JR Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan

    Dai Akiyama & Dai Mohri

  8. Department of Gastroenterology, Kanto Central Hospital, 6-25-1 Kamiyouga, Setagaya-ku, Tokyo, 158-8531, Japan

    Dai Akiyama

Authors
  1. Kazunaga Ishigaki
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  2. Tsuyoshi Hamada
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  3. Yousuke Nakai
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  4. Hiroyuki Isayama
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  10. Suguru Mizuno
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  11. Hirofumi Kogure
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  12. Yukiko Ito
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  17. Minoru Tada
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  18. Kazuhiko Koike
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Contributions

KI, TH, HI, and YN conceived and designed the study, analyzed and interpreted the data, and drafted the article. TS, RH, KS, TS, NT, SM, HK, YI, HY, SM, DA, DM, MT, and KK critically revised the article for important intellectual content. All authors contributed to the final approval of the article.

Corresponding author

Correspondence to Yousuke Nakai.

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Conflict of interest

Yousuke Nakai and Hiroyuki Isayama received research grant from Boston Scientific Japan. The other authors have no conflicts of interest to declare.

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Ishigaki, K., Hamada, T., Nakai, Y. et al. Retrospective Comparative Study of Side-by-Side and Stent-in-Stent Metal Stent Placement for Hilar Malignant Biliary Obstruction. Dig Dis Sci 65, 3710–3718 (2020). https://doi.org/10.1007/s10620-020-06155-z

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  • DOI: https://doi.org/10.1007/s10620-020-06155-z

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