Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 25, 2015; 7(9): 889-894
Published online Jul 25, 2015. doi: 10.4253/wjge.v7.i9.889
Comparison of endoscopic stenting for malignant biliary obstruction: A single-center study
Ryuichi Yamamoto, Masatomo Takahashi, Yasuyo Osafune, Katsuya Chinen, Shingo Kato, Sumiko Nagoshi, Koji Yakabi
Ryuichi Yamamoto, Masatomo Takahashi, Yasuyo Osafune, Katsuya Chinen, Shingo Kato, Sumiko Nagoshi, Koji Yakabi, Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama 350-8550, Japan
Author contributions: Yamamoto R and Takahashi M contributed equally to this work; Yamamoto R, Takahashi M, Osafune Y, Chinen K, Kato S, Nagoshi S and Yakabi K performed the research; Yamamoto R analyzed the data; and Yamamoto R wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Saitama Medical Center, Saitama Medical University Institutional Review Board.
Informed consent statement: All study participants provided informed consent prior to study enrollment.
Conflict-of-interest statement: No financial relationships relevant to this publication were disclosed.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at ryuichi5118@gmail.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected byan in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ryuichi Yamamoto, MD, PhD, Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama 350-8550, Japan. ryuichi5118@gmail.com
Telephone: +81-49-2283564 Fax: +81-49-2256649
Received: November 21, 2014
Peer-review started: November 23, 2014
First decision: December 12, 2014
Revised: May 2, 2015
Accepted: June 18, 2015
Article in press: June 19, 2015
Published online: July 25, 2015
Processing time: 255 Days and 22.1 Hours
Abstract

AIM: To evaluate the efficacy and safety of single-step endoscopic placement of self-expandable metallic stents (SEMS) for treatment of obstructive jaundice.

METHODS: A retrospective study was performed among 90 patients who underwent transpapillary biliary metallic stent placement for malignant biliary obstruction (MBO) between April 2005 and October 2012. The diagnosis of primary disease and MBO was based on abdominal ultrasound, computed tomography, magnetic resonance imaging, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography with brush cytology, biopsy, and/or a combination of these modalities. The type of SEMS (covered or non-covered, 8 mm or 10 mm in diameter) was determined by the endoscopist. Ninety patients were divided into two groups: group 1 (49 patients) who underwent a single-step SEMS placement and group 2 (41 patients) who underwent a two-step SEMS placement. The technical success rate, complication rate, stent patency, and patient survival rate were compared between the groups. In addition, to identify the clinical prognostic factors associated with patient survival, the following variables were evaluated in Cox-regression analysis: gender, age, etiology of MBO (pancreatic cancer or non-pancreatic cancer), clinical stage (IVb; with distant metastases or IVa >; without distant metastases), chemotherapy (with or without), patency of the stent, and the use of single-step or two-step SEMS.

RESULTS: Immediate technical success was achieved in 93.9% (46/49) in group 1 and in 95.1% (39/41) in group 2, with no significant difference (P = 1.0). Similarly, there was no difference in the complication rates between the groups (group 1, 4.1% and group 2, 4.9%; P = 0.62). Stent failure was observed in 10 cases in group 1 (20.4%) and in 16 cases in group 2 (39.0%). The patency of stent and patient survival revealed no difference between the two groups with Kaplan-Meier analysis, with a mean patency of 111 ± 17 d in group 1 and 137 ± 19 d in group 2 (P = 0.91), and a mean survival of 178 ± 35 d in group 1 and 222 ± 23 d in group 2 (P = 0.57). On the contrary, the number of days of hospitalization associated with first-time SEMS placement in group 1 was shorter when compared with that number in group 2 (28 vs 39 d; P < 0.05). Multivariate analysis revealed that a clinical stage of IVa > (P = 0.0055), chemotherapy (P = 0.0048), and no patency of the stent (P = 0.011) were independent prognostic factors associated with patient survival.

CONCLUSION: Our results showed that single-step endoscopic metal stent placement was safe and effective for treating obstructive jaundice secondary to various inoperable malignancies.

Keywords: Endoscopic stenting; Single-step; Malignant biliary obstruction; Self-expandable metallic stents; Two-step

Core tip: Single-step placement of expandable metallic stents for treating malignant biliary obstruction is useful for shortening hospitalization. To maximize symptomatic relief and cost benefits, stent placement should not be delayed after deciding on metal stent palliation.