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Comparison of endoscopic bilateral metal stent drainage with plastic stents in the palliation of unresectable hilar biliary malignant strictures: Large multicenter study.
- Source :
-
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society [Dig Endosc] 2021 Jan; Vol. 33 (1), pp. 179-189. Date of Electronic Publication: 2020 Jun 07. - Publication Year :
- 2021
-
Abstract
- Background: Endoscopic stenting to manage malignant hilar biliary obstruction has no consensus regarding the optimal stenting strategy. In this multicenter study, we compared transpapillary parallel-style bilateral metal stenting with bilateral plastic stenting, and evaluated short- and long-term outcomes.<br />Methods: We recruited 262 consecutive patients (Bismuth classification types II-IV) who underwent either bilateral metal or plastic stenting as primary therapy at four tertiary centers. To overcome selection bias, we performed 1:1 propensity score matching. Our primary outcome was overall survival.<br />Results: After propensity score matching, each group comprised 96 patients, with no significant differences in any baseline characteristics. The median survival was significantly longer in the metal stenting group than in the plastic stenting group (7.2 months [95% CI 6.0-8.5] vs. 4.1 months [95% CI 2.9-5.3]; P = 0.015). The clinical success rates were significantly higher in the metal stenting group than in the plastic stenting group (99.0% vs. 71.9%, respectively; P < 0.001), and lower post-procedure cholangitis incidence (7.3% vs. 26.0%; P < 0.001), longer median symptom-free stent patency (9.2 months [95% CI 7.6-10.6] vs. 4.8 months [95% CI 4.2-5.3]; P < 0.001), and fewer total interventions (1.3 ± 0.6 vs. 2.0 ± 1.4; P < 0.001). In multivariate Cox analysis of the overall survival, metal stenting (HR 0.589, P = 0.002), hilar cholangiocarcinoma (HR 0.419, P = 0.009), and adjuvant treatment (HR 0.596, P = 0.006) were independent predictors of death.<br />Conclusions: Endoscopic therapy using bilateral metal stenting is superior to bilateral plastic stenting, with prolonged overall survival, higher clinical success, and longer stent patency in patients with advanced hilar biliary malignancies.<br /> (© 2020 Japan Gastroenterological Endoscopy Society.)
- Subjects :
- Bile Ducts, Intrahepatic
Cholangiopancreatography, Endoscopic Retrograde
Constriction, Pathologic
Drainage
Humans
Palliative Care
Plastics
Stents
Treatment Outcome
Bile Duct Neoplasms complications
Bile Duct Neoplasms surgery
Cholangiocarcinoma complications
Cholangiocarcinoma surgery
Cholestasis etiology
Cholestasis surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1443-1661
- Volume :
- 33
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society
- Publication Type :
- Academic Journal
- Accession number :
- 32249460
- Full Text :
- https://doi.org/10.1111/den.13680