Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2025; 17(8): 108579
Published online Aug 27, 2025. doi: 10.4240/wjgs.v17.i8.108579
Outcomes of iodine-125 seed strips combined with double self-expandable metallic stent for Bismuth type III and IV malignant biliary obstruction
Chuan-Guo Zhou, Yong Zhang, Hui Li, Ke-Yun Liu, Xiang-Yu Yang, Kun Gao
Chuan-Guo Zhou, Yong Zhang, Hui Li, Ke-Yun Liu, Xiang-Yu Yang, Kun Gao, Department of Interventional Radiology, Beijing Chaoyang Hospital, The Affiliated Hospital of Capital Medical University, Beijing 100020, China
Co-corresponding authors: Chuan-Guo Zhou and Kun Gao.
Author contributions: Zhou CG analyzed the data, wrote and revised the manuscript; Zhou CG and Gao K conceived and designed the study, confirmed the authenticity of all raw data as the co-corresponding authors; Zhou CG, Zhang Y, Li H, Liu KY, Yang XY, and Gao K performed the interventional procedure; all authors have read and approved the manuscript.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Informed consent statement: Informed consent from the patients was waived by the committee because the study was retrospective.
Conflict-of-interest statement: We have no financial relationships to disclose.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
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: Chuan-Guo Zhou, MD, Department of Interventional Radiology, Beijing Chaoyang Hospital, The Affiliated Hospital of Capital Medical University, No. 8 Gongren Tiyuchang Nan Road, Chaoyang District, Beijing 100020, China. zhoucg3949_cn@sina.com
Received: April 22, 2025
Revised: May 30, 2025
Accepted: June 30, 2025
Published online: August 27, 2025
Processing time: 125 Days and 21.8 Hours
Abstract
BACKGROUND

No reports have been published on the use of iodine-125 (125I) seed strips combined with double biliary self-expandable metallic stent (SEMS) for the treatment of type III and IV hilar malignant biliary obstruction (MBO).

AIM

To evaluate effectiveness and safety of 125I seed trips combined with double SEMS in treating Bismuth type III and IV hilar MBO.

METHODS

This was a retrospective, observational study conducted from April 2017 to December 2022. Patients with Bismuth-Corlette type III and IV hilar MBO who underwent 125I seed strip implantation combined with double SEMS placement were analyzed. Patient demographics, clinical characteristics, SEMS implantation methods, procedural and clinical outcomes, overall survival, stent patency duration, and complications were evaluated.

RESULTS

Four types of stent implantation were utilized: (1) Type X; (2) Type T; (3) Type Y; and (4) Tandem type. The technical success rate was 94.1% (16/17), and the clinical success rate was 100% (17/17). The median overall survival time was 189.00 days ± 47.27 days (95%CI: 96.35-281.66). The median stent fluency time was 154.00 days ± 12.19 days (95%CI: 130.11-177.89). No serious complications were observed.

CONCLUSION

This retrospective, observational study suggests that the combination of 125I seed strips with double SEMS may be a safe and potentially effective approach for managing type III and IV hilar MBO patients.

Keywords: Iodine-125 seeds; Self-expandable metallic stent; Hilar malignant biliary obstruction; Hilar cholangiocarcinoma; Case series study

Core Tip: This study explores the innovative use of iodine-125 seed strips combined with double self-expandable metallic stent for treating Bismuth type III and IV hilar malignant biliary obstruction. In a retrospective analysis of 17 patients from April 2017 to December 2022, we achieved a technical success rate of 94.1% and a clinical success rate of 100%. The median overall survival was 189 days, with stent patency lasting an average of 154 days. No serious complications were reported, indicating that this combination therapy is a safe and effective treatment option for these patients.