PMID- 37392955
OWN - NLM
STAT- Publisher
LR  - 20231020
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 98
IP  - 5
DP  - 2023 Nov
TI  - Utility of bilateral intraductal plastic stent for malignant hilar biliary 
      obstruction compared with bilateral self-expandable metal stent: a propensity 
      score-matched cohort analysis.
PG  - 776-786
LID - S0016-5107(23)02703-7 [pii]
LID - 10.1016/j.gie.2023.06.053 [doi]
AB  - BACKGROUND AND AIMS: Intraductal plastic stent (IS) placement for unresectable 
      malignant hilar biliary obstruction (UMHBO) is an effective option for biliary 
      drainage. However, the effectiveness of bilateral IS placement compared with 
      bilateral self-expandable metal stent (SEMS) placement remains unclear. METHODS: 
      Overall, 301 patients with UMHBO were enrolled; 38 patients underwent bilateral 
      IS placement (IS group) and 38 patients underwent SEMS placement (SEMS group) in 
      the propensity score-based cohort. Both groups were compared for technical and 
      clinical success, adverse events (AEs), recurrent biliary obstruction (RBO), time 
      to RBO (TRBO), overall survival (OS), and endoscopic reintervention (ERI). 
      RESULTS: No significant differences were observed between the groups regarding 
      technical and clinical success, AEs and RBO occurrence rates, TRBO, or OS. The 
      median initial endoscopic procedure time was significantly shorter in the IS 
      group (23 vs 49 minutes, P < .01). ERI was performed on 20 and 19 patients in the 
      IS and SEMS groups, respectively. The median ERI procedure time was significantly 
      shorter in the IS group (22 vs 35 minutes, P = .04). Median TRBO after ERI with 
      plastic stent placement tended to be longer in the IS group (306 vs 56 days, P = 
      .068). A Cox multivariate analysis showed that the IS group was the significant 
      related factor for TRBO after ERI (hazard ratio, .31; 95% confidence interval, 
      .25-.82; P = .035). CONCLUSIONS: Bilateral IS placement can reduce the duration 
      of the endoscopic procedure and provide sufficient stent patency both initially 
      and after ERI stent placement, and the stents are removable. Bilateral IS 
      placement is considered a good option for initial UMHBO drainage. (Clinical trial 
      registration number: UMIN000050546.).
CI  - Copyright (c) 2023 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Okuno, Mitsuru
AU  - Okuno M
AD  - Department of Gastroenterology, Gifu University Municipal Hospital, Gifu, Japan.
FAU - Iwata, Keisuke
AU  - Iwata K
AD  - Department of Gastroenterology, Gifu University Municipal Hospital, Gifu, Japan.
FAU - Iwashita, Takuji
AU  - Iwashita T
AD  - First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
FAU - Mukai, Tsuyoshi
AU  - Mukai T
AD  - Department of Gastroenterology, Gifu University Municipal Hospital, Gifu, Japan; 
      Department of Gastroenterological Endoscopy, Kanazawa Medical University, 
      Ishikawa, Japan.
FAU - Shimojo, Kota
AU  - Shimojo K
AD  - Department of Gastroenterology, Gifu University Municipal Hospital, Gifu, Japan.
FAU - Ohashi, Yosuke
AU  - Ohashi Y
AD  - Department of Gastroenterology, Gifu University Municipal Hospital, Gifu, Japan.
FAU - Iwasa, Yuhei
AU  - Iwasa Y
AD  - Department of Gastroenterology, Gifu University Municipal Hospital, Gifu, Japan.
FAU - Senju, Akihiko
AU  - Senju A
AD  - First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
FAU - Iwata, Shota
AU  - Iwata S
AD  - First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
FAU - Tezuka, Ryuichi
AU  - Tezuka R
AD  - First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
FAU - Ichikawa, Hironao
AU  - Ichikawa H
AD  - First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
FAU - Mita, Naoki
AU  - Mita N
AD  - First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
FAU - Uemura, Shinya
AU  - Uemura S
AD  - First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
FAU - Yoshida, Kensaku
AU  - Yoshida K
AD  - Department of Gastroenterology, Gifu Prefecture General Medical Center, Gifu, 
      Japan.
FAU - Maruta, Akinori
AU  - Maruta A
AD  - Department of Gastroenterology, Gifu Prefecture General Medical Center, Gifu, 
      Japan.
FAU - Tomita, Eiichi
AU  - Tomita E
AD  - Department of Gastroenterology, Gifu University Municipal Hospital, Gifu, Japan.
FAU - Yasuda, Ichiro
AU  - Yasuda I
AD  - Third Department of Internal Medicine, University of Toyama, Toyama, Japan.
FAU - Shimizu, Masahito
AU  - Shimizu M
AD  - First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
LA  - eng
PT  - Journal Article
DEP - 20230629
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
COIS- Disclosure All authors disclosed no financial relationships. This work was 
      supported by JSPS KAKENHI (grant no. JP23K14646, Mitsuru Okuno).
EDAT- 2023/07/02 01:10
MHDA- 2023/07/02 01:10
CRDT- 2023/07/01 19:15
PHST- 2023/03/25 00:00 [received]
PHST- 2023/05/27 00:00 [revised]
PHST- 2023/06/21 00:00 [accepted]
PHST- 2023/07/02 01:10 [pubmed]
PHST- 2023/07/02 01:10 [medline]
PHST- 2023/07/01 19:15 [entrez]
AID - S0016-5107(23)02703-7 [pii]
AID - 10.1016/j.gie.2023.06.053 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2023 Nov;98(5):776-786. doi: 10.1016/j.gie.2023.06.053. Epub 
      2023 Jun 29.