INTRADUCTAL VERSUS TRANSPAPILLARY FULLY COVERED SELF - EXPANDABLE METAL STENT PLACEMENT FOR MALIGNANT BILIARY STRICTURES

Endoscopic transpapillary placement of a self-expandable metal stent (SEMS) for treatment of a malignant biliary stricture has been widely accepted as a standard palliative biliary drainage technique. A fully covered SEMS (FCSEMS) can be removed and can prevent tumor ingrowth. Duodenobiliary reflux though a biliary stent placed across the major duodenal papilla is considered to be a predisposing factor for stent occlusion and cholangitis. Intraductal placement of a biliary stent above the duodenal papilla (inside stent) may be associated with longer stent patency and a lower occlusion rate by reducing duodenobiliary reflux. The aim of this study was to determine whether intraductal FCSEMS placement (IP) or transpapillary FCSEMS placement (TP) is a better therapeutic technique for malignant biliary strictures. From January 2016 to October 2017, a total of 51 patients with malignant biliary strictures were retrospectively enrolled in this study. The patients were divided into an IP group (n = 19) and TP group (n = 32). Technical and clinical success, complications, and stent patency were compared between the two groups. There were no significant differences between the IP and TP groups in the rates of technical success (100% vs. 100%, respectively), clinical success (100% vs. 100%), early complications (5.3% vs. 0.0%), late complications (0.0% vs. 3.1%), stent occlusion (10.5% vs. 15.6%), tumor ingrowth (0.0% vs. 0.0%), overgrowth (0.0% vs. 6.3%), or sludge formation (10.5% vs. 9.4%) or in the median stent patency (101.5 vs. 102.0 days). Cumulative stent patency also did not differ significantly between the two groups (P = 0.680). TP for malignant biliary strictures showed a high technical success rate, low complication rate, and no difference in stent patency when compared with IP. Long-term follow-up and prospective comparative studies are needed to evaluate the usefulness of IP.