Percutaneous insertion of long-covered biliary stents in patients with malignant duodenobiliary stricture

Objective To investigate the technical feasibility, safety, and efficacy of a long-covered biliary stent in patients with malignant duodenobiliary stricture. Methods This retrospective study enrolled 57 consecutive patients (34 men, 23 women; mean age, 64 years; range, 32–85 years) who presented with malignant duodenobiliary stricture between February 2019 and November 2020. All patients were treated with a long (18 or 23 cm)-covered biliary stent. Results The biliary stent deployment was technically successful in all 57 patients. The overall adverse event rate was 17.5% (10 of 57 patients). Successful internal drainage was achieved in 55 (96.5%) of 57 patients. The median patient survival and stent patency times were 99 days (95% confidence interval [CI], 58–140 days) and 73 days (95% CI, 60–86 days), respectively. Fourteen (25.5%) of the fifty-five patients presented with biliary stent dysfunction due to sludge ( n = 11), tumor overgrowth ( n = 1), collapse of the long biliary stent by a subsequently inserted additional duodenal stent ( n = 1), or rapidly progressed duodenal cancer ( n = 1). A univariate Cox proportional hazards model did not reveal any independent predictor of biliary stent patency. Conclusions Percutaneous insertion of a subsequent biliary stent was technically feasible after duodenal stent insertion. Percutaneous insertion of a long-covered biliary stent was safe and effective in patients with malignant duodenobiliary stricture. Clinical relevance statement In patients with malignant duodenobiliary stricture, percutaneous insertion of a long-covered biliary stent was safe and effective regardless of duodenal stent placement. Key Points • Percutaneous insertion of long-covered biliary stents in patients with malignant duodenobiliary stricture is a safe and effective procedure. • Biliary stent deployment was technically successful in all 57 patients and successful internal drainage was achieved in 55 (96.5%) of 57 patients. • The median patient survival and stent patency times were 99 days and 73 days, respectively, after placement of a long-covered biliary stent in patients with duodenobiliary stricture.