Endoscopic Stenting for Malignant Biliary Obstruction: Results of a Nationwide Experience
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...
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| Format: | Article |
| Language: | English |
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Korean Society of Gastrointestinal Endoscopy
2021-09-01
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| Series: | Clinical Endoscopy |
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| Online Access: | http://www.e-ce.org/upload/pdf/ce-2021-016.pdf |
| _version_ | 1797428272924983296 |
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| author | Jeanne Lubbe Gabriel Sandblom Urban Arnelo Eduard Jonas Lars Enochsson |
| author_facet | Jeanne Lubbe Gabriel Sandblom Urban Arnelo Eduard Jonas Lars Enochsson |
| author_sort | Jeanne Lubbe |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-09T08:56:42Z |
| format | Article |
| id | doaj.art-efe418f5f671429faf4368f833545aa9 |
| institution | Directory Open Access Journal |
| issn | 2234-2400 2234-2443 |
| language | English |
| last_indexed | 2024-03-09T08:56:42Z |
| publishDate | 2021-09-01 |
| publisher | Korean Society of Gastrointestinal Endoscopy |
| record_format | Article |
| series | Clinical Endoscopy |
| spelling | doaj.art-efe418f5f671429faf4368f833545aa92023-12-02T13:07:06ZengKorean Society of Gastrointestinal EndoscopyClinical Endoscopy2234-24002234-24432021-09-0154571372110.5946/ce.2021.0167538Endoscopic Stenting for Malignant Biliary Obstruction: Results of a Nationwide ExperienceJeanne Lubbe0Gabriel Sandblom1Urban Arnelo2Eduard Jonas3Lars Enochsson4 Department of Clinical Sciences, Intervention and Technology, Centre for Digestive Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Department of Surgery, Södersjukhuset, Stockholm, Sweden Department of Surgical and Perioperative Sciences, Umeå University, Umeå University Hospital, Umeå, Sweden Department of Surgery, University of Cape Town Faculty of Health Sciences, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, Bellville, South Africa Department of Surgical and Perioperative Sciences, Umeå University, Umeå University Hospital, Umeå, SwedenBackground/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.http://www.e-ce.org/upload/pdf/ce-2021-016.pdfendoscopichilarmalignantobstructionstent |
| spellingShingle | Jeanne Lubbe Gabriel Sandblom Urban Arnelo Eduard Jonas Lars Enochsson Endoscopic Stenting for Malignant Biliary Obstruction: Results of a Nationwide Experience Clinical Endoscopy endoscopic hilar malignant obstruction stent |
| title | Endoscopic Stenting for Malignant Biliary Obstruction: Results of a Nationwide Experience |
| title_full | Endoscopic Stenting for Malignant Biliary Obstruction: Results of a Nationwide Experience |
| title_fullStr | Endoscopic Stenting for Malignant Biliary Obstruction: Results of a Nationwide Experience |
| title_full_unstemmed | Endoscopic Stenting for Malignant Biliary Obstruction: Results of a Nationwide Experience |
| title_short | Endoscopic Stenting for Malignant Biliary Obstruction: Results of a Nationwide Experience |
| title_sort | endoscopic stenting for malignant biliary obstruction results of a nationwide experience |
| topic | endoscopic hilar malignant obstruction stent |
| url | http://www.e-ce.org/upload/pdf/ce-2021-016.pdf |
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