Comparison of 6-mm and 10-mm-diameter, fully-covered, self-expandable metallic stents for distal malignant biliary obstruction

Shota Harai; Susumu Hijioka; Yoshikuni Nagashio; Akihiro Ohba; Yuta Maruki; Daiki Yamashige; Yuya Hisada; Motohiro Yoshinari; Hidetoshi Kitamura; Kosuke Maehara; Yumi Murashima; Yuki Kawasaki; Takehiko Koga; Kotaro Takeshita; Hideki Ueno; Shunsuke Kondo; Chigusa Morizane; Mitsuharu Fukasawa; Miyuki Sone; Yutaka Saito; Nobuyuki Enomoto; Takuji Okusaka

doi:10.1055/a-2039-4316

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(04): E340-E348
DOI: 10.1055/a-2039-4316

Original article

Comparison of 6-mm and 10-mm-diameter, fully-covered, self-expandable metallic stents for distal malignant biliary obstruction

Authors

Shota Harai

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan

²University of Yamanashi, Faculty of Medicine Graduate School of Medicine, First Department of Internal Medicine, Yamanashi, Japan
Susumu Hijioka

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Yoshikuni Nagashio

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Akihiro Ohba

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Yuta Maruki

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Daiki Yamashige

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Yuya Hisada

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Motohiro Yoshinari

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Hidetoshi Kitamura

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Kosuke Maehara

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Yumi Murashima

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Yuki Kawasaki

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Takehiko Koga

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Kotaro Takeshita

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Hideki Ueno

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Shunsuke Kondo

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Chigusa Morizane

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan
Mitsuharu Fukasawa

²University of Yamanashi, Faculty of Medicine Graduate School of Medicine, First Department of Internal Medicine, Yamanashi, Japan
Miyuki Sone

³National Cancer Center Japan, Department of Diagnostic Radiology, Tokyo, Japan
Yutaka Saito

⁴National Cancer Center Japan, Department of Endoscopy, Tokyo, Japan
Nobuyuki Enomoto

²University of Yamanashi, Faculty of Medicine Graduate School of Medicine, First Department of Internal Medicine, Yamanashi, Japan
Takuji Okusaka

¹National Cancer Center Japan, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan

Abstract

Background and study aims For distal malignant biliary obstruction, self-expandable metallic stents (SEMSs) have a larger inner diameter compared to plastic stents, which prolongs time to recurrent biliary obstruction (TRBO), although stent-related complications are still a problem. This study aimed to compare the outcomes between using 10– and 6-mm-diameter fully-covered SEMS (FCSEMS) for distal malignant biliary obstruction.

Patients and methods This single-center, retrospective study included patients with 10-mm or 6-mm-diameter FCSEMS to treat distal malignant biliary obstruction. Clinical success, stent-related adverse events (AEs), cumulative incidence of RBO, factors involved in stent-related AEs, and factors involved in RBO were evaluated.

Results There were 243 eligible cases between October 2017 and December 2021. The cumulative incidence of RBO did not differ significantly between the 10-mm and 6-mm groups. Stent-related AEs occurred in 31.6 % and 11.4 % of patients between the 10-mm and 6-mm groups, respectively (P < 0.01). Pancreatitis occurred in 10.5 % and 3.6 % (P = 0.04) and cholecystitis occurred in 11.8 % and 3.0 % of patients (P = 0.03) in the 10-mm and 6-mm groups, respectively. In multivariate analysis, the 6-mm stent was extracted as a factor linked to a reduced risk of AEs, but not as a risk factor of RBO.

Conclusions The 6-mm-diameter FCSEMS for distal malignant biliary obstruction is a well-balanced stent with a cumulative incidence of RBO compatible to that of the 10-mm-diameter FCSEMS and fewer stent-related AEs.

Full Text

References

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