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

Table 1 Patient characteristics at baseline

Characteristics	Sequential group, overall	Sequential group, side by side	Sequential group, stent in stent	Simultaneous group	P value
Number of patients	73	35	38	62
Male	41 (56)	21 (51)	20 (49)	35 (56)	0.82
Age, years, median	71	71	71	68	0.59
Tumor type					0.32
Cholangiocarcinoma	34 (47)	19 (54)	15 (39)	38 (61)
Hilar metastasis	34 (47)	14 (40)	20 (53)	21 (34)
Hepatocarcinoma	5 (6)	2 (6)	3 (8)	3 (5)
Bismuth and Corlette classification					0.053
II	1 (1)	0 (0)	1 (2)	8 (12)
IIIa	17 (23)	11 (31)	6 (16)	9 (15)
IIIb	5 (7)	2 (6)	3 (8)	9 (15)
IV	50 (69)	22 (63)	28 (74)	36 (58)
Bilirubin rate, day 0, μmol/L, median (IQR)	224 (158-340)	238 (162-342)	220 (150-338)	225 (132-334)	0.80
Postoperative chemotherapy	25 (36)	14 (42)	11 (30)	31 (53)	0.095
Survival time, days, median (IQR)	61 (39-78)	69 (43-128)	43 (27-65)	67 (56-105)	0.24

Data are presented as n (%). IQR: Interquartile range.

Table 2 Univariate and multivariate analyses for technical success

Variables	Univariate analysis, OR	Univariate analysis, 95%CI	Univariate analysis, P value	Multivariate analysis, OR	Multivariate analysis, 95%CI	Multivariate analysis, P value
Baseline bilirubin rate	0.98	0.63-1.52	0.931	0.90	0.51-1.57	0.703
Bismuth and Corlette type IV	0.50	0.17-1.45	0.202	0.23	0.42-1.22	0.085
Hilar metastasis	0.45	0.17-1.19	0.106	0.27	0.06-1.10	0.068

OR: Odds ratio; CI: Confidence interval.

Table 3 Patient outcomes

Patient outcomes	Sequential group, overall	Sequential group, side by side	Sequential group, stent in stent	Simultaneous group	P value
Technical success	56 (77)			58 (94)	0.008
	56 (77)	20 (57)	36 (95)	58 (94)	0.001
Clinical success (n = 101)	33 (72)	13 (76)	20 (69)	41 (75)	0.82
Procedure duration, minutes, median (IQR)	80 (60-90)	75 (35-93)	80 (60-90)	72 (58-99)	0.75
Early adverse event
Overall	23 (31)	12 (34)	11 (29)	12 (21)	0.39
Pancreatitis	8 (11)	4 (11)	4 (11)	5 (8)	0.81
Cholangitis	12 (16)	6 (17)	6 (16)	4 (6)	0.19
Hemorrhage	2 (3)	1 (3)	1 (3)	4 (6)	0.66
Duodenal perforation	1 (1)	1 (3)	0 (0)	0 (0)	0.26
Recurrent biliary obstruction	9 (18)	1 (5)	8 (20)	13 (22)	0.049
Time to RBO, days, mean	112	1821	103	144
Reintervention after RBO	9 (100)	1 (100)	8 (100)	11 (85)	0.49
Successful reintervention	7 (78)	1 (100)	6 (75)	9 (82)	1

¹n = 1. Data are presented as n (%). RBO: Recurrent biliary obstruction; IQR: Interquartile range.