Guilmoteau T, Rouquette O, Buisson A, Cambier S, Abergel A, Poincloux L. Direct comparison of simultaneous and sequential endoscopic metallic bilateral stenting in malignant hilar biliary obstruction. World J Gastroenterol 2025; 31(19): 101913 [DOI: 10.3748/wjg.v31.i19.101913]
Corresponding Author of This Article
Thomas Guilmoteau, MD, Digestive Endoscopy Unit, Estaing University Hospital, 1 Place Lucie Et Raymond Aubrac, Clermont-Ferrand 63000, Auvergne-Rhône-Alpes, France. tguilmoteau@chu-clermontferrand.fr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an 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/
World J Gastroenterol. May 21, 2025; 31(19): 101913 Published online May 21, 2025. doi: 10.3748/wjg.v31.i19.101913
Direct comparison of simultaneous and sequential endoscopic metallic bilateral stenting in malignant hilar biliary obstruction
Thomas Guilmoteau, Olivier Rouquette, Anthony Buisson, Sébastien Cambier, Armand Abergel, Laurent Poincloux
Thomas Guilmoteau, Olivier Rouquette, Laurent Poincloux, Digestive Endoscopy Unit, Estaing University Hospital, Clermont-Ferrand 63000, Auvergne-Rhône-Alpes, France
Anthony Buisson, Department of Gastroenterology, Estaing University Hospital, Clermont-Ferrand 63000, Auvergne-Rhône-Alpes, France
Sébastien Cambier, Biostatistics Unit, Department of Clinical Research and Innovation, Clermont-Ferrand University Hospital, Clermont-Ferrand 63000, Auvergne-Rhône-Alpes, France
Armand Abergel, Department of Hepatology and Gastroenterology, Estaing University Hospital, Clermont-Ferrand 63000, Auvergne-Rhône-Alpes, France
Author contributions: Guilmoteau T, Rouquette O, and Poincloux L conceived and designed the analysis; Guilmoteau T collected the data; Cambier S and Buisson A contributed data or analysis tools; Guilmoteau T and Poincloux L performed the analysis; Guilmoteau T, Rouquette O, Buisson A, Cambier S, Abergel A, and Poincloux L contributed to interpretation and final approval of the manuscript.
Institutional review board statement: The study was approved by local Ethics Committee (IRB00013412, “CHU de Clermont Ferrand IRB #1”, IRB number 2023-CF003) with compliance to the French policy of individual data protection and was performed in accordance with the principles of the Declaration of Helsinki.
Informed consent statement: Informed consent was waived because of the retrospective nature of the study, and the analysis used anonymous clinical data.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Thomas Guilmoteau, MD, Digestive Endoscopy Unit, Estaing University Hospital, 1 Place Lucie Et Raymond Aubrac, Clermont-Ferrand 63000, Auvergne-Rhône-Alpes, France. tguilmoteau@chu-clermontferrand.fr
Received: September 30, 2024 Revised: March 18, 2025 Accepted: April 17, 2025 Published online: May 21, 2025 Processing time: 232 Days and 9 Hours
Abstract
BACKGROUND
Endoscopic bilateral biliary drainage is a first line palliative treatment for unresectable malignant hilar biliary obstruction (MHBO) but remains technically challenging. The emergence of self-expandable metallic stents carried by an ultra-thin (6 Fr or smaller) delivery system now permits simultaneous bilateral stent placement. To date, only a few studies have compared this new method with conventional sequential bilateral stenting.
AIM
To evaluate a possible superiority of simultaneous “side by side” (SBS) biliary drainage in unresectable MHBO.
METHODS
We identified 135 patients who benefited from bilateral drainage using uncovered self-expandable metallic stents between 2010 and 2023. Among them, 62 benefited from simultaneous SBS bilateral drainage between 2017 and 2023, and 73 benefited from sequential bilateral drainage [38 using “stent in stent” (SIS) technique and 35 using SBS technique between 2010 and 2017].
RESULTS
Technical success was significantly increased in simultaneous drainage compared with sequential drainage (94% vs 75%, P = 0.008). However, simultaneous SBS drainage and sequential SIS drainage had a similar technical success (94% vs 95%). We observed no differences regarding clinical success, procedure duration and recurrent biliary obstruction rate. Stent patency was shorter in the SIS group compared with the simultaneous group (103 days vs 144 days). Early adverse events were more frequent in the sequential group (31% vs 21%, P = 0.205), with no differences regarding SIS or SBS technique. Technical failure was associated with a higher rate of infectious fatal adverse events (9.5% vs 1.7%, P = 0.02). Reintervention after recurrent biliary obstruction seems to be more successful after using SBS rather than SIS techniques (83% vs 75%, P = 0.53).
CONCLUSION
Simultaneous SBS metallic stent placement using an ultra-thin delivery system was technically easier and as efficient as sequential bilateral stenting in unresectable MHBO to achieve bilateral drainage. The SIS procedure remains a good option in unresectable MHBO.
Core Tip: This retrospective study focused on the different drainage techniques using endoscopic retrograde cholangiopancreatography for malignant hilar biliary obstruction. It highlighted the benefits of parallel drainage, particularly when performed simultaneously using ultra-thin delivery devices. This resulted in a clear advantage in terms of technical success and reduced the risk of complications associated with technical failure, which was more frequently observed in the case of sequential drainage, especially in a “side by side” fashion.
