SIR 2024
Gastrointestinal Interventions
Cathal o'Leary, MD (he/him/his)
Clinical Fellow
University Health Network, Toronto, Canada
Financial relationships: Full list of relationships is listed on the CME information page.
Eran Shlomovitz, MD FACS
Surgeon Interventional Radiologist
Toronto General Hospital, Canada
Disclosure information not submitted.
Stent reconstruction permits external drainage catheter removal in patients with malignant hilar biliary obstruction (MHO). Recent guidelines advise draining >50% of liver {1,2}. Common stent configurations are unilateral, or bilateral in T or Y configurations. This study reviews a 10-year experience with each approach.
Materials and Methods:
A retrospective review of 49 patients (M/F = 27/22, mean age 60.7±13.4 years) with MHO, Bismuth II-IV, who had 51 percutaneous biliary stents placed between Sep 1st 2013–Sep 1st 2023, at a single tertiary hospital. The cause of MHO was cholangiocarcinoma in 57.1% (28/49) and metastases in 42.9% (21/49) of patients.
Biliary stenting was performed with uncovered, 8-10mm diameter, nitinol stents (Niti-S, TaeWoong Medical, Los Angeles, USA) in unilateral or bilateral configurations. Bilateral stents took ‘T’ or ‘Y’ configurations using a stent-in-stent approach. Clinical success was defined as removal of external drainage.
Descriptive statistics summarized patient and stent characteristics and outcomes. Inferential analysis for associations used the Chi-square or Fisher’s exact test (categorical outcomes), and Mann-Whitney test or Kruskal-Wallis tests (numerical outcomes).
Results:
Table 1 summarizes the subgroups. Unilateral stents trended to a lower clinical success than bilateral stents (63.2% vs 77%, p = 0.339). Y stents had a significantly higher clinical success rate than T stents (92.3% vs 56.3%, p=0.044). Y stents had a trend to higher rates of stent dysfunction (38.5% vs 31.3%, p=0.689) and complication rate (69.2% vs 37.5%, p=0.058)
Conclusion:
Malignant hilar obstructions (MHOs) require careful deliberation of quality of life versus risks of future interventions. Bilateral biliary stenting may offer higher clinical success rates compared to unilateral stenting. Of bilateral approaches, Y stenting offers higher clinical success rate but may carry a higher complication rate.