The placement of multiple plastic stents still has important roles in candidates for chemotherapy for unresectable perihilar cholangiocarcinoma

Abstract

Background/Purpose: Placement of uncovered self-expandable metallic stents (U-SEMSs) of patients with unresectable perihilar cholangiocarcinoma (UPHC) is recommended as the treatment of first choice to address bile stasis. The aim of this study was to determine which of the following two endoscopic stents might be the stent of first choice for the treatment of biliary stasis in patients with UPHC: plastic stents (PSs) or U-SEMSs. Methods: U-SEMSs, deployed as a stent-in-stent, were selected as the stents of first choice from 2013 and 2014, while PSs began to be selected as the stents of first choice from 2015 onward. Results: The median time to recurrent biliary obstruction were 66 days in the PS group (N = 38) and 105 days in the U-SEMS group (N = 37; P = .04). Emergency endoscopy was necessitated in 76.3% (29/38) of patients of the PS group and 54.1% (20/37) of patients of the U-SEMS group (P = .0434). The success rate of the first reintervention was 96.5% (27/29) in the PS group and 55% (11/20) in the U-SEMS group (P = .0002). Sustainable chemotherapy could be carried out in 55.2% of patients in the PS group and 32.4% of patients in the U-SEMS group (P = .0472). Multivariate analysis identified selection of U-SEMS as the stent of first choice as the only independent factor predictive of successful reintervention (P = .0016, odds ratio = 0.058). However, the stent selection was not an independent factor for feasible chemotherapy. Conclusions: Plastic stent placement could enhance the success rate of reintervention in patients with UPHC and might be facilitated by sustainable chemotherapy. However, stent selection might not have an influence on the prognosis.

Diagnosis and Treatment of Perihilar Cholangiocarcinoma: A National Survey from the Korean Pancreatobiliary Association

“…Patients with pCCA might undergo re-intervention for re-biopsy or recurrent cholangitis, and re-intervention has been shown to be easier using plastic stents. 35 When endoscopic biliary drainage is performed, most respondents (73.9%) preferred bilateral drainage over unilateral drainage. This finding was probably influenced by a Korean multicenter, prospective, randomized study.…”

Segment 3 cholangiojejunostomy for unresectable peri‐hilar cholangiocarcinoma: A case report and literature review

“…Both self‐expanding metallic stents and plastic stents are usually used for perihilar cholangiocarcinoma. Both types of stents seem to have similar success rates, but the use of plastic stents is associated with earlier recurrence of biliary obstruction, which may require recurrent reintervention 4 …”

Nationwide treatment and outcomes of perihilar cholangiocarcinoma

“…Patients with a diagnosis in an academic center that underwent supportive care had higher survival rates compared to those diagnosed in non‐academic centres. Although data that can explain this difference is lacking, it is likely drainage strategies at least can be partially attributed 39‐42 . Also the available expertise on treatment of biliary and periampullary tumours present in academic centres, often with dedicated physicians with regular multidisciplinary meetings is likely beneficiary for every aspect of pCCA treatment, including best supportive care.…”

“…Although data that can explain this difference is lacking, it is likely drainage strategies at least can be partially attributed. 39 , 40 , 41 , 42 Also the available expertise on treatment of biliary and periampullary tumours present in academic centres, often with dedicated physicians with regular multidisciplinary meetings is likely beneficiary for every aspect of pCCA treatment, including best supportive care. Regional meetings could help non‐academic centre to access this expertise in order toenhance knowledge on pCCA treatment and to improve supportive care.…”