Bilateral stenting methods for hilar biliary obstructions

Abstract

OBJECTIVE:There is no consensus regarding the most appropriate methods (i.e., the side-by-side versus the stent-in-stent technique) for placing bilateral stents for malignant hilar biliary obstructions. We aimed to perform a quantitative review of the published data regarding the clinical efficacy of the side-by-side and stent-in-stent bilateral drainage techniques for hilar biliary obstructions.METHODS:A comprehensive search of several databases was conducted and a fixed-effects or random-effects model was used to pool the data from all of the study end-points.RESULTS:Four clinical trials were identified. A comparison of the side-by-side and stent-in-stent groups revealed no significant differences with respect to the rates of successful placement, successful drainage, early complications, late complications and stent occlusions. There were also no significant inter-group differences in stent patency and patient survival and no publication bias was observed.CONCLUSIONS:The performance of the side-by-side technique appears to be similar to that of the stent-in-stent technique for bilateral drainage in patients with malignant hilar biliary obstructions.

Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017

“…The "side-by-side" and "stent-in-stent" positioning of multiple SEMSs have been found equivalent in a meta-analysis (4 studies, 158 patients) with respect to the rates of successful stent placement, successful drainage, early and late complications, and stent occlusions [201]. The choice of the technique thus seems to be at the discretion of the endoscopist, with the "side-by-side" and "stent-in-stent" techniques more frequently used in Western and Asian countries, respectively.…”

The application of Compont gel in chronic obstructive jaundice rats model

“…It is important for survival after orthotopic liver transplantation. However, biliary tract and pancreatic stents have a certain rate of recurrent obstruction 25 , and the specific mechanism of function is still unclear. Considering that there is a certain correlation between the material of the biliary stent 26 - 28 and the individual differences of the patient, the function of the biliary muscle layer and the endothelium may also be a factor that cannot be ignored.…”

Fully covered metal biliary stents: A review of the literature

“…Stent placement in the hilar region is technically difficult, and can be managed by unilateral or bilateral stenting (Figures 2D and 2E ). Bilateral stenting can be approached via stent in stent or side by side approach[ 91 ].…”