Endoscopic re-intervention after stent-in-stent versus side-by-side bilateral self-expandable metallic stent deployment.

Tomohisa Iwai, Mitsuhiro Kida, Kosuke Okuwaki, Hiroshi Yamauchi, Toru Kaneko, Rikiya Hasegawa, Masafumi Watanabe, Takahiro Kurosu, Hiroshi Imaizumi, Wasaburo Koizumi

Journal of gastroenterology and hepatology 2022 Jun

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Endoscopic bilateral self-expandable metallic stent (SEMS) placement for unresectable malignant hilar biliary obstruction (MHBO) is widely performed; however, re-intervention after recurrent biliary obstruction (RBO) is often challenging. We compared stent-in-stent (SIS) and side-by-side (SBS) SEMS placement for MHBO considering re-intervention for RBO. One hundred five consecutive patients with MHBO who underwent endoscopic bilateral SEMS placement in our hospital and its affiliated institutions were enrolled in this study; 75 patients underwent partial SIS deployment between December 2005 and December 2012; and 30 underwent SBS deployment between January 2013 and March 2019. Initial treatments and re-interventions in each group were retrospectively evaluated. Technical success rate (92% vs 100%, P = 0.179), procedure duration (46 vs 35 min, P = 0.382), functional success rate (97.1% vs 100%, P = 1.00), complication rate (24.6% vs 20.0%, P = 0.797), time to RBO (260 vs 312 days; Gray test, P = 0.815), and rate of RBO (59.4% vs 70.0%, P = 0.371) were not significantly different between the SIS and SBS groups. However, bilateral re-stenting with plastic stents through SEMS was successful in 63.4% of patients in the SIS group compared with 100% of patients in the SBS group (P = 0.0013). Median time to RBO upon first re-stenting with a plastic stent was 75 days (range, 11-195 days). Endoscopic re-stenting after RBO was significantly more successful in the SBS group than in the SIS group. SBS method is suitable for MHBO considering revisionary stent placement. © 2022 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Citation

Tomohisa Iwai, Mitsuhiro Kida, Kosuke Okuwaki, Hiroshi Yamauchi, Toru Kaneko, Rikiya Hasegawa, Masafumi Watanabe, Takahiro Kurosu, Hiroshi Imaizumi, Wasaburo Koizumi. Endoscopic re-intervention after stent-in-stent versus side-by-side bilateral self-expandable metallic stent deployment. Journal of gastroenterology and hepatology. 2022 Jun;37(6):1060-1066