Suprapapillary placement of plastic versus metal stents for malignant biliary hilar obstructions: a multicenter, randomized trial

Kanno, Yoshihide; Ito, Kei; Nakahara, Kazunari; Kawaguchi, Shinya; Masaki, Yoshiharu; Okuzono, Toru; Kato, Hironari; Kuwatani, Masaki; Ishii, Shotaro; Murabayashi, Toji; Hasegawa, Shuichi; Nagahama, Masatsugu; Iwashita, Yuji; Michikawa, Yosuke; Terada, Shuzo; Kawakami, Yoshiyuki; Fujii, Yuki; Kawakubo, Kazumichi

doi:10.1016/j.gie.2023.03.007

Cited by 16 publications

(4 citation statements)

References 26 publications

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“…The major concern with uncovered stents remains the risk for obstruction by tumor ingrowth, resulting in recurrent cholangitis. For this reason, some groups have opted for new therapy modalities using plastic or intraductal papillary stents [33,34]. RFA has great potential in this regard, with results that demonstrated improved stent patency and improved patient survival.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis

de Oliveira Veras,

de Moura,

McCarty

et al. 2023

Endosc Int Open

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Background and study aims: Recurrent biliary stent occlusion and tumor ingrowth remain a major concern among patients with malignant biliary obstruction (MBO) with significant impact on patient morbidity and survival. Intraductal radiofrequency ablation (RFA) has emerged as a promising treatment that seeks to extend stent patency. This study aimed to evaluate the impact of RFA on overall survival (OS) and stent patency among patients with unresectable MBO. Methods: A comprehensive search of electronic databases was performed for randomized controlled trials (RCTs) comparing RFA plus biliary stent (RFA+S) versus biliary stent alone (S-alone). Outcomes assessed included overall survival, stent patency, and adverse events (AEs) with mean difference (MD) calculated from pooled proportions. Subgroup analyses were performed for hilar strictures and cholangiocarcinoma (CCA). Results: Six RCTs (n = 439 patients) were included and demonstrated improved survival among patients who received RFA+S (MD 85.80 days; 95% confidence interval [CI] 35.02-136.58; I2 = 97%; P < 0.0009). The pooled MD for total stent patency was 22.25 days (95% CI 17.38- 61.87; I2 = 97%; P = 0.27). There was no difference in AEs between RFA+S vs S-alone (P > 0.05). On subgroup analyses, RFA+S was associated with improved stent patency (MD 76.73 days; 95% CI 50.11-103.34; I2 = 67%; P <0.01) and OS (MD 83.14 (95% CI 29.52-136.77; I2 = 97%; P < 0.01] for CCA. For hilar strictures, stent patency was improved among patients with RFA+S [MD 83.71 days (95% CI 24.85-142.56; I2 = 84%; P < 0.01]. Conclusions: RFA+S improved OS in the treatment of MBO when compared with S-alone. Moreover, the RFA therapy prolonged stent patency in hilar strictures and CCA, with similar rates of AEs.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis

de Oliveira Veras,

de Moura,

McCarty

et al. 2023

Endosc Int Open

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“…However, bilateral biliary drainage may ultimately be required for unilateral IS placement and bilateral IS placement provides a larger drainage area. Additionally, a randomized controlled trial reported that the stent patency of bilateral IS placement was similar to that of bilateral SEMS placement 22 . Considering the utility of bilateral IS placement, spending a few extra minutes on bilateral placement seems worthwhile for managing UMHBO.…”

Section: Discussionmentioning

confidence: 96%

“…Additionally, a randomized controlled trial reported that the stent patency of bilateral IS placement was similar to that of bilateral SEMS placement. 22 Considering the utility of bilateral IS placement, spending a few extra minutes on bilateral placement seems worthwhile for managing UMHBO.…”

Section: Discussionmentioning

confidence: 99%

Comparison of unilateral and bilateral intraductal plastic stent placement for unresectable malignant hilar biliary obstruction: A propensity score‐matched cohort analysis

Okuno,

Iwata,

Mukai

et al. 2023

J Hepato Biliary Pancreat

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BackgroundAlthough intraductal plastic stent (IS) placement is an effective treatment for unresectable malignant hilar biliary obstruction (UMHBO), the effectiveness of unilateral and bilateral IS drainage remains controversial. This retrospective study investigated the effectiveness of bilateral IS placement for UMHBO using the propensity score matching method.MethodsPatients who underwent transpapillary endoscopic stenting for UMHBO were analyzed for technical and clinical success, adverse events, and time to recurrent biliary obstruction (TRBO).ResultsA total of 321 patients were enrolled in the study with 27 patients in each unilateral and bilateral IS group in the propensity score‐based cohort. Technical success was 100%, while clinical success was 93% and 96% in the unilateral and bilateral IS groups, respectively (p = 1.0). Cholecystitis occurred in 4% and 7%, respectively (p = 1.0). The median TRBO was shorter in the unilateral group (129 [5–383] days) than that in the bilateral group (226 [16–563] days) (p = .0281). Bilateral IS placement was an independent long TRBO factor (hazard ratio [HR] 0.46; 95% confidence interval [CI]: 0.21–0.97; p = .041).ConclusionsUnilateral and bilateral IS placement had high technical and clinical success rates in primary stent placement. However, bilateral IS placement showed a longer TRBO. Bilateral IS placement may be a good option for initial UMHBO drainage.

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“…Recently, encouraging data of suprapapillary inside stents for biliary strictures have been reported, and threaded inside plastic stents have been increasingly utilized to manage hilar strictures 1 2 3 . Although a knotted nylon thread is attached to the distal end, endoscopic retrieval of a completely migrated inside stent is sometimes challenging.…”

Section: Figmentioning

confidence: 99%

The “coupler” technique for endoscopic removal of a threaded inside stent that migrated above tight hilar strictures

Kitagawa,

Murakoshi,

Ishikawa

2023

Endoscopy

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Suprapapillary placement of plastic versus metal stents for malignant biliary hilar obstructions: a multicenter, randomized trial

Cited by 16 publications

References 26 publications

Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis

Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis

Comparison of unilateral and bilateral intraductal plastic stent placement for unresectable malignant hilar biliary obstruction: A propensity score‐matched cohort analysis

The “coupler” technique for endoscopic removal of a threaded inside stent that migrated above tight hilar strictures

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