Efficacy Analysis of Suprapapillary versus Transpapillary Self-Expandable Metal Stents According to the Level of Obstruction in Malignant Extrahepatic Biliary Obstruction
Sung Yong Han,
Tae Hoon Lee,
Sung Ill Jang,
Dong Uk Kim,
Jae Kook Yang,
Jae Hee Cho,
Min Je Sung,
Chang-Il Kwon,
Jin-Seok Park,
Seok Jeong,
Don Haeng Lee,
Sang-Heum Park,
Dong Ki Lee
Affiliations
Sung Yong Han
Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
Tae Hoon Lee
Department of Internal Medicine, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
Sung Ill Jang
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Dong Uk Kim
Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
Jae Kook Yang
Department of Internal Medicine, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
Jae Hee Cho
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Min Je Sung
Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
Chang-Il Kwon
Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
Jin-Seok Park
Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
Seok Jeong
Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
Don Haeng Lee
Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
Sang-Heum Park
Department of Internal Medicine, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
Dong Ki Lee
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Background/Aims: The use of a self-expandable metal stent (SEMS) is recommended for unresectable malignant biliary obstruction (MBO). Stent-related adverse events might differ according to the position of the stent through the ampulla of Vater (AOV). We retrospectively evaluated SEMS patency and adverse events according to the position of the SEMS.Methods: In total, 280 patients who underwent endoscopic SEMS placement due to malignant distal biliary obstruction were analyzed retrospectively. Suprapapillary and transpapillary SEMS insertions were performed on 51 patients and 229 patients, respectively.Results: Between the suprapapillary group (SPG) and transpapillary group (TPG), the stent patency period was not significantly different (median [95% confidence interval]: 107 days [82.3 to 131.7] vs 120 days [99.3 to 140.7], p=0.559). There was also no significant difference in the rate of adverse events. In subgroup analysis, the stent patency for an MBO located within 2 cm from the AOV was found to be significantly shorter than that for an MBO located more than 2 cm from the AOV in the SPG (64 days [0 to 160.4] vs 127 days [82.0 to 171.9], p<0.001) and TPG (87 days [52.5 to 121.5] vs 130 [97.0 to 162.9], p<0.001). Patients with an MBO located within 2 cm from the AOV in both groups had a higher percentage of duodenal invasion (SPG: 40.0% vs 4.9%, p=0.002; TPG: 28.6% vs 2.9%, p<0.001) than patients with an MBO located more than 2 cm from the AOV.Conclusions: The SPG and TPG showed similar results in terms of stent patency and rate of adverse events. However, patients with an MBO located within 2 cm from the AOV had a higher percentage of duodenal invasion with shorter stent patency than those with an MBO located more than 2 cm from the AOV, regardless of stent position.
