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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Biliary metal stents should be placed near the hilar duct in distal malignant biliary stricture patients
Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Yoshinori Okubo, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Ryoichiro Kobashi, Takumi Yanagita, Takuto Hikichi, Hiromasa Ohira
Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Yoshinori Okubo, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Ryoichiro Kobashi, Takumi Yanagita, Hiromasa Ohira, Department of Gastroenterology, Fukushima Medical University, Fukushima 9601295, Japan
Yoshinori Okubo, Jun Nakamura, Minami Hashimoto, Tsunetaka Kato, Ryoichiro Kobashi, Takuto Hikichi, Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 9601295, Japan
Author contributions: Sugimoto M wrote the paper and designed and performed the study; Takagi T and Ohira H designed and oversaw the study; Suzuki R, Konno N, HA, Hikichi T, Nakamura J, Takasumi M, Sato Y, Irie H, Okubo Y, Hashimoto M, Kato T, Kobashi R, and Yanagita T provided clinical advice; and all the authors read and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of Fukushima Medical University, No. 2453.
Informed consent statement: The patients were not required to give informed consent because this study used anonymous clinical data obtained after each patient had agreed to medical activities by written consent. For full disclosure, the details of this study are published on the home page of Fukushima Medical University.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets analyzed during the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Mitsuru Sugimoto, MD, PhD, Assistant Professor, Department of Gastroenterology, Fukushima Medical University, 1 Hikarigaoka, Fukushima 9601295, Japan. kitachuuou335@yahoo.co.jp
Received: September 17, 2021
Peer-review started: September 17, 2021
First decision: November 16, 2021
Revised: December 4, 2021
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: May 7, 2022
ARTICLE HIGHLIGHTS
Research background
Endoscopic biliary drainage using a self-expanding metallic stent (SEMS) has a longer patency period than endoscopic biliary drainage using a plastic stent. Therefore, endoscopic SEMS placement is desirable for the treatment of unresectable distant malignant biliary obstruction (DMBO).
Research motivation
The type of SEMS that should be used for DMBO is a point of active discussion. However, the appropriate position for SEMS insertion is unknown.
Research objectives
To clarify the appropriate SEMS insertion point for DMBO.
Research methods
Among 135 DMBO patients who underwent SEMS placement, 127 patients with biliary obstruction between the junction of the cystic duct and Vater’s papilla were enrolled. In 83 patients (Hilar group), an SEMS was placed through the upper common bile duct within 2 cm from the biliary hilar duct. In the other 44 patients (Lower group), an SEMS was placed near the top of the biliary obstruction. The patency period was compared between the Hilar group and Lower group. The risk factors for SEMS dysfunction were also investigated.
Research results
The patency period of SEMS was significantly longer in the Hilar group patients. Multivariate analysis revealed that the Lower group classification was the only significant risk factor for SEMS dysfunction.
Research conclusions
SEMS placement near the biliary hilar duct extends the patency period in DMBO patients.
Research perspectives
SEMS placement near the biliary hilar duct might prevent obstructive jaundice and cholangitis and contribute to improved prognosis in DMBO patients.
