Reintervention for stent occlusion after bilateral self-expandable metallic stent placement for malignant hilar biliary obstruction

Abstract

Objectives

Endoscopic reintervention for stent occlusions following bilateral self-expandable metallic stent (SEMS) placements for malignant hilar biliary obstructions (MHBO) is challenging, and the time to recurrent biliary obstruction (RBO) of the revisionary stent remains unclear. We aimed to clarify a suitable reintervention method for stent occlusions following bilateral SEMS placements for MHBO.

Methods

Between 2002 and 2014, 52 consecutive patients with MHBO who underwent endoscopic reinterventions for stent occlusions after bilateral SEMS placements were enrolled at two university hospitals and one tertiary care referral center. We retrospectively evaluated the technical and functional success rates of the reinterventions, and the time to RBO of the revisionary stents.

Results

The technical and functional success rates of the reinterventions were 92% (48/52) and 90% (43/48), respectively. The univariate analysis did not determine any significant predictive factors for technical and functional failures. The median time to RBO of the revisionary stents was 68 days. The median time to RBO was significantly longer for revisionary SEMS placements than for plastic stent placements (131 days vs. 47 days, respectively; log-rank test, P = 0.005). Revisionary SEMS placement was the only independent factor that was significantly associated with a longer time to RBO of the revisionary stent in the multivariate Cox proportional hazards analysis (hazard ratio 0.37; 95% confidence interval 0.14–0.95; P = 0.039).

Conclusions

Revisionary SEMS placement is a suitable endoscopic reintervention method for stent occlusions following bilateral SEMS placements from the perspective of the time to RBO of the revisionary stents. This article is protected by copyright. All rights reserved.

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