Percutaneous stent placement for malignant hilar biliary obstruction: side-by-side versus stent-in-stent technique

Zhou, Wei-Zhong; Liu, Sheng; Yang, Zheng-Qiang; Xian, Yu-Tao; Xu, Hong-Dou; Wu, Jun-Zheng; Shi, Haibin

doi:10.21203/rs.2.24611/v2

Cited by 2 publications

(15 citation statements)

References 6 publications

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“…Our median survival time (285.5 days) was comparable to those of previous studies with endoscopic methods and LCD stents (114-300 days) (13,16,18), open-weave, cross-wired stents (180-383 days) (14,16,17,(29)(30)(31), or those with percutaneous open-cell, partially covered large cell, or covered stents placement (143-299 days) (11,(20)(21)(22)(24)(25)(26), although a direct comparison is impossible. One study noticed that once successful biliary drainage had been obtained, median stent patency and survival time were similar between the percutaneous and endoscopic approaches (20).…”

Section: Discussionsupporting

confidence: 77%

“…Complications occurred at a lower rate in this study (5.9%) compared with previous studies with endoscopic SIS placement with LCD stents (7.0%-29.0%) (12,13,16,18,28) or percutaneous conventional opencell and partially covered large cell or covered stents placement (7.7%-33.3%) (11,(20)(21)(22)(23)(24)(25)(26).…”

Section: Discussioncontrasting

confidence: 64%

“…In addition, successful internal drainage (88.2%) was obtained in the majority of patients without major complications. Several previous studies (11,(20)(21)(22)(23)(24)(25)(26) investigated the technical outcomes of percutaneous metallic stent placement in patients with MHBO. Reported technical success and successful internal drainage rates were 93.0%-100.0% and 87.5%-100.0%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The median stent patency and stent occlusion rate in our study (179 days and 35.6%, respectively) showed comparable outcomes to those reported by the aforementioned studies applying an endoscopic method using LCD stents (105-202 days and 42.0%-63.2%, respectively) (12,13,15,16,18,28), open-weave, crosswired stents (150-253 days and 6.0%-44.1%, respectively) (14,16,17,(29)(30)(31), or a percutaneous method with conventional open-cell and partially covered large cell or covered stents (75-330 days and 17.5%-48.4%, respectively) (11,(20)(21)(22)(23)(24)(25)(26). The differences in the definitions of the stent patency period do have to be taken into account.…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous stent-in-stent placement with large cell-type stents for malignant hilar biliary obstruction

Kim

Gwon

et al. 2020

Acta Radiol

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Background To overcome the technical difficulty of bilateral stent-in-stent placement, large cell-type biliary stents have been developed. However, most of the studies using large cell-type stents were conducted with endoscopic method. Purpose To evaluate the efficacy and safety of percutaneous stent placement with a stent-in-stent method using large cell-type stents in patients with malignant hilar biliary obstruction. Material and Methods From December 2015 and October 2018, 51 patients with malignant hilar biliary obstruction were retrospectively studied. All of the patients underwent bilateral (n=46) or unilateral (n=5) stenting in a T, Y, or X configuration with a stent-in-stent method using large cell-type stents. Technical success, complications, successful internal drainage, stent patency, and patient survival were analyzed. Results A total of 118 stents were successfully placed in 51 patients (100.0%). Three patients had minor complications with self-limiting hemobilia. Major complications were not observed in any patient. Successful internal drainage was achieved in 45 patients (88.2%). Clinical follow-up information until death or the end of the study was available for 50 of 51 patients. The median patient survival was 285.5 days (95% confidence interval [CI] 197–374). Stent dysfunction occurred in 16 patients (35.6%) due to tumor ingrowth (n=9) or tumor ingrowth combined with biliary sludge (n=7) among the patients who achieved successful internal drainage. Median stent patency was 179 days (95% CI 104–271). Conclusion Percutaneous stent-in-stent placement with large cell-type stents is technically feasible and safe, and can be an effective technique in patients with malignant hilar biliary obstruction.

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Section: Discussionsupporting

confidence: 77%

Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Percutaneous stent-in-stent placement with large cell-type stents for malignant hilar biliary obstruction

Kim

Gwon

et al. 2020

Acta Radiol

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“…Asia-Pacific Working Group recommended that biliary stent should drain more than 50% of the entire liver [7]. Therefore, bilateral stenting is preferred among a majority of researchers [11][12][13][14][15][16][17]. There are two commonly used bilateral stenting techniques, which include side-by-side (SBS) and stent-in-stent (SIS) strategies.…”

Section: Introductionmentioning

confidence: 99%

Side-by-side versus stent-in-stent bilateral stenting for malignant hilar biliary obstruction: a meta-analysis.

Chen¹,

Gao²,

Li³

et al. 2022

Videosurgery and Other Miniinvasive Techniques

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Introduction: Both side-by-side (SBS) and stent-in-stent (SIS) bilateral stenting have been used for patients with malignant hilar biliary obstruction (MHBO). However, it is unclear which technique is better. Aim: This meta-analysis is conducted to investigate the clinical efficacy and safety of SBS and SIS bilateral stenting for patients with MHBO. Material and methods: Relevant studies were searched in PubMed, Embase, Cochrane Library, Wanfang, VIP, and CINK databases. The timeline for the searches was from the establishment of the database to September 2021. The relative outcomes are pooled. Results: A total of 7 studies fulfilled the inclusion criteria and entered into this meta-analysis. The pooled technical success rate was significant higher in the SIS group than that in the SBS group (p = 0.04). The pooled early complication rate was significantly lower in the SIS group than in the SBS group (p = 0.04). The pooled stent re-obstruction rate was significantly lower in the SBS group than in the SIS group (p = 0.04). The pooled stent patency duration was significantly longer in the SBS group than in the SIS group (p = 0.01). The pooled functional success rates (p = 0.79), total complication rates (p = 0.34), and overall survival duration (p = 0.27) were comparable between 2 groups. Egger test did not show any publication bias. Conclusions: When comparing the SBS and SIS bilateral stenting for patients with MHBO, although SIS technique may have the superiorities of technical success and early complication rates, the longer stent patency was achieved by the SBS technique.

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Percutaneous stent placement for malignant hilar biliary obstruction: side-by-side versus stent-in-stent technique

Cited by 2 publications

References 6 publications

Percutaneous stent-in-stent placement with large cell-type stents for malignant hilar biliary obstruction

Percutaneous stent-in-stent placement with large cell-type stents for malignant hilar biliary obstruction

Side-by-side versus stent-in-stent bilateral stenting for malignant hilar biliary obstruction: a meta-analysis.

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