Prospective comparison of endoscopic bilateral stent-in-stent versus stent-by-stent deployment for inoperable advanced malignant hilar biliary stricture

Published:March 21, 2019DOI:https://doi.org/10.1016/j.gie.2019.03.011

      Background and Aims

      Although the efficacy of palliative bilateral biliary drainage using self-expandable metal stents has been demonstrated, it is unclear which bilateral method is optimal for advanced malignant hilar biliary strictures (MHSs). This pilot study compared bilateral stent-in-stent (SIS) with stent-by-stent (SBS) deployment for advanced MHSs.

      Methods

      Patients with inoperable high-grade MHSs were enrolled in this prospective randomized multicenter study. The primary outcome was the rate of adverse events, whereas secondary outcomes were technical and clinical success, reintervention, therapeutic outcomes, stent patency, and survival duration.

      Results

      This study randomized 69 of 74 pathologically diagnosed patients to the SIS (n = 34) or SBS (n = 35) groups. The total adverse event rate after stent deployment did not differ between the 2 groups (23.5% in the SIS group vs 28.6% in the SBS group, P = .633). The primary technical success rate was 100% (34/34) and 91.4% (32/35) in the SIS and SBS groups, respectively (P = .081). The clinical success rate was 94.1% (32/34) and 90.6% (29/32), respectively (P = .668). The stent patency rate at 3 months was 85.3% in the SIS group and 65.7% in the SBS group (P = .059). At 6 months, the stent patency rate was 47.1% and 31.4%, respectively (P = .184). The median cumulative stent patency and survival probability did not differ between the 2 groups.

      Conclusions

      Efficacy of bilateral SIS and SBS deployment may be similar in terms of total adverse events, technical and clinical success, stent patency, and survival. The stent patency rates at 3 and 6 months was higher in the SIS group without statistical difference. (Clinical trial registration number: NCT01141088.)

      Abbreviations:

      IHD (intrahepatic duct), MHS (malignant hilar biliary stricture), SBS (stent-by-stent), SEMS (self-expandable metal stent), SIS (stent-in-stent)
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      Linked Article

      • Side by side or stent within stent: the beauty is in the eye of the beholder
        Gastrointestinal EndoscopyVol. 90Issue 2
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          We read with much interest the article by Lee et al1 entitled “Prospective comparison of endoscopic bilateral stent-in-stent (SIS) versus stent-by-side (SBS) deployment for inoperable advanced malignant biliary stricture.” The intervention in question is the choice between an SBS deployment of uncovered stents versus an SIS deployment of self-expanding metallic stents in bilateral hepatic ducts for inoperable malignant biliary obstruction.
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