Endoscopic stenting for malignant biliary obstruction: results of a nationwide experience
Date
2021-05
Journal Title
Journal ISSN
Volume Title
Publisher
Korean Society of Gastrointestinal Endoscopy
Abstract
Background/Aims: Many unanswered questions remain about the treatment of malignant hilar obstruction. We investigated
endoscopic stenting for malignant biliary strictures, as reported in a nationwide registry.
Methods: All endoscopic retrograde cholangiopancreatography (ERCP) procedures entered in the Swedish Registry of Gallstone
Surgery and ERCP from January 2010 to December 2017 in which stenting was performed for malignant biliary stricture
management were included in this study. Patency was estimated by determining the time to reintervention.
Results: Endoscopic stenting was performed for malignant stricture management in 4623 ERCP procedures, of which 1364
(29.5%) were performed for hilar strictures. Of the hilar strictures, 320 (23.5%) were intrahepatic strictures (Bismuth–Corlette III–
IV). Adverse events were more common after hilar stenting than after distal stenting (17.2% vs. 12.0%, p<0.0001). The 6-month
reintervention rate was 73.4% after hilar stenting compared with 55.9% after distal stenting (p<0.0001). The 6-month reintervention
rates for Bismuth–Corlette types I, II, IIIa, IIIb, and IV were 70.4%, 75.6%, 90.0%, 87.5%, and 85.7%, respectively. In multivariate
analysis, the risk for reintervention was three times higher after hilar stenting than after distal stenting (hazard ratio 3.47, 95%
confidence interval 2.01–6.00, p<0.001).
Conclusions: This study with a relatively large patient cohort undergoing endoscopic stenting confirms that stenting for malignant hilar
obstruction has more adverse events and lower patency than stenting for distal malignant obstruction. Clin Endosc 2021;54:713-721
Description
CITATION: Lubbe, J. et al 2021. Endoscopic Stenting for Malignant Biliary Obstruction: Results of a Nationwide Experience. Clinical Endoscopy 54(2021):713-721 pages. doi.10.5946/ce.2021.016
The original publication is available at: e-ce.org
The original publication is available at: e-ce.org
Keywords
Endoscopic retrograde cholangiopancreatography, Endoscopic surgery, Bile ducts -- Obstructions
Citation
Lubbe, J. et al 2021. Endoscopic Stenting for Malignant Biliary Obstruction: Results of a Nationwide Experience. Clinical Endoscopy 54(2021):713-721 pages. doi.10.5946/ce.2021.016