Efficacy Analysis of Suprapapillary versus Transpapillary Self-Expandable Metal Stents According to the Level of Obstruction in Malignant Extrahepatic Biliary Obstruction

• Published in: Gut and liver Vol. 17; no. 5; pp. 806 - 813
• Main Authors: Han, Sung Yong, Lee, Tae Hoon, Jang, Sung Ill, Kim, Dong Uk, Yang, Jae Kook, Cho, Jae Hee, Sung, Min Je, Kwon, Chang-Il, Park, Jin-Seok, Jeong, Seok, Lee, Don Haeng, Park, Sang-Heum, Lee, Dong Ki
• Format: Journal Article
• Language: English
• Published: Korea (South) Editorial Office of Gut and Liver 01.09.2023; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: adverse events; ampulla of vater; bile duct neoplasms; endoscopic retrograde cholangiopancreatography; Original; self expandable metallic stents; 내과학; Endoscopic retrograde cholangiopancreatography; Self expandable metallic stents; Bile duct neoplasms; Adverse events; Ampulla of Vater
• ISSN: 1976-2283; 2005-1212; 2005-1212
• DOI: 10.5009/gnl220437

The use of a self-expandable metal stent (SEMS) is recommended for unresectable malignant biliary obstruction (MBO). Stent-related adverse events might differ according to the position of the stent through the ampulla of Vater (AOV). We retrospectively evaluated SEMS patency and adverse events according to the position of the SEMS. In total, 280 patients who underwent endoscopic SEMS placement due to malignant distal biliary obstruction were analyzed retrospectively. Suprapapillary and transpapillary SEMS insertions were performed on 51 patients and 229 patients, respectively. Between the suprapapillary group (SPG) and transpapillary group (TPG), the stent patency period was not significantly different (median [95% confidence interval]: 107 days [82.3 to 131.7] vs 120 days [99.3 to 140.7], p=0.559). There was also no significant difference in the rate of adverse events. In subgroup analysis, the stent patency for an MBO located within 2 cm from the AOV was found to be significantly shorter than that for an MBO located more than 2 cm from the AOV in the SPG (64 days [0 to 160.4] vs 127 days [82.0 to 171.9], p<0.001) and TPG (87 days [52.5 to 121.5] vs 130 [97.0 to 162.9], p<0.001). Patients with an MBO located within 2 cm from the AOV in both groups had a higher percentage of duodenal invasion (SPG: 40.0% vs 4.9%, p=0.002; TPG: 28.6% vs 2.9%, p<0.001) than patients with an MBO located more than 2 cm from the AOV. The SPG and TPG showed similar results in terms of stent patency and rate of adverse events. However, patients with an MBO located within 2 cm from the AOV had a higher percentage of duodenal invasion with shorter stent patency than those with an MBO located more than 2 cm from the AOV, regardless of stent position.