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

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 27; no. 10; pp. 700 - 711
• Main Authors: Iwasaki, Akito, Kubota, Kensuke, Kurita, Yusuke, Hasegawa, Sho, Fujita, Yuji, Kagawa, Koji, Kato, Shingo, Sekino, Yusuke, Hosono, Kunihiro, Nakajima, Atsushi
• Format: Journal Article
• Language: English
• Published: Tokyo Wiley Subscription Services, Inc 01-10-2020
• Subjects: Chemotherapy; Cholangiocarcinoma; perihilar cholangiocarcinoma; plastic stent; reintervention; Stents; uncovered SEMS
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1002/jhbp.804

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.
Highlight
Placement of uncovered self‐expandable metallic stents is recommended as the treatment of choice in patients with unresectable perihilar cholangiocarcinoma. Iwasaki and colleagues conclude that plastic stent placement could enhance the success rate of reintervention in these patients and might facilitate sustainable chemotherapy. Stent selection, however, may not affect the prognosis.