Direct comparison of simultaneous and sequential endoscopic metallic bilateral stenting in malignant hilar biliary obstruction

Figure 1  Sequential stent in stent bilateral drainage on X-ray view.

Figure 2 Sequential side by side bilateral drainage on X-ray and endoscopic view. A: Placement of guidewires across the strictures; B: Dilation of left stricture; C: Dilation of right stricture; D: Simultaneous placement of two metallic biliary stents; E: Endoscopic view after drainage with two biliary self-expandable metallic stent well distinct in the duodenal lumen.

Figure 3 Flow diagram of the participants analyzed. EUS-BD: Endoscopic ultrasound-guided biliary drainage; PTBD: Percutaneous transhepatic biliary drainage; ERCP: Endoscopic retrograde cholangiopancreatography.

Figure 4 Adverse event and recurrent biliary obstruction outcomes. A: Rate of early adverse events among groups; B: Repartition of severity according the Adverse Event Gastrointestinal Endoscopy classification among patients who suffered from an adverse event; C: Kaplan-Meier curves compared recurrent biliary obstruction-free survival between simultaneous and sequential groups; D: Repartition of severity according to the Adverse Event Gastrointestinal Endoscopy classification among patients with cholangitis. AGREE: Adverse Event Gastrointestinal Endoscopy; SBS: Side by side; SIS: Stent in stent.