The role of stent placement above the papilla (inside-stent) as a bridging therapy for perihilar biliary malignancy: an initial experience

Purpose Although endoscopic naso-biliary drainage (ENBD) is a popular preoperative biliary drainage (PBD) method for patients with perihilar biliary malignancy (PHBM), patient discomfort caused by the nasal tube remains a problem. This study aimed to analyze the safety and efficacy of PBD with the p...

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Bibliographic Details
Published in:Surgery today (Tokyo, Japan) Japan), 2021-11, Vol.51 (11), p.1795-1804
Main Authors: Takahashi, Yu, Sasahira, Naoki, Sasaki, Takashi, Inoue, Yosuke, Mise, Yoshihiro, Sato, Takafumi, Ono, Yoshihiro, Oba, Atsushi, Saiura, Akio, Ito, Hiromichi
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Bile Duct Neoplasms - complications
Bile Duct Neoplasms - surgery
Cholestasis - etiology
Cholestasis - surgery
Drainage - methods
Feasibility Studies
Female
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Original Article
Plastics
Recurrence
Safety
Stents - adverse effects
Surgery
Surgical Oncology
Time Factors
Treatment Outcome
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Summary:Purpose Although endoscopic naso-biliary drainage (ENBD) is a popular preoperative biliary drainage (PBD) method for patients with perihilar biliary malignancy (PHBM), patient discomfort caused by the nasal tube remains a problem. This study aimed to analyze the safety and efficacy of PBD with the placement of a plastic stent above the papilla [inside-stent (IS)] as a bridging therapy. Methods The outcomes of 78 patients with potentially resectable PHBM, of whom 29 underwent IS placement and 49 underwent ENBD were evaluated. Results The stent-associated complication rates were not different between the two groups (7% in the IS group and 10% in the ENBD group, P  = 0.621). Catheter dislocation occurred less frequently (0% vs. 22%, P  = 0.016), and the median time to recurrent biliary obstruction was longer (not reached vs. 32 days, P  = 0.039) in the IS group than in the ENBD group. Among the patients who underwent resection, their postoperative severe complication rates were not substantially different (26% vs. 25%, P  = 0.923). Conclusion IS placement is a possible alternative to ENBD as a bridge to a definitive operation for patients with resectable PHBM and a prospective trial to prove its feasibility and safety is therefore warranted.
ISSN:0941-1291
1436-2813
DOI:10.1007/s00595-021-02268-8