Potential of 6-mm-diameter fully covered self-expandable metal stents for unresectable malignant distal biliary obstruction: a propensity score-matched study
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Background/Aims: To date, only thinner-diameter metal stents have been evaluated for unresectable malignant distal biliary obstruction(UR-MDBO). This study investigated the outcomes and optimal cohorts for a 6-mm-diameter fully covered self-expandable metalstent (FCSEMS) compared with those for a 10-mm-diameter FCSEMS. Methods: This single-center retrospective cohort study included patients who underwent initial transpapillary metal stenting forUR-MDBO. Propensity score matching (1:1) analysis was performed. Results: Of 133/68 patients who underwent 6-mm/10-mm-diameter FCSEMS deployment, 59 in each group were selected. The mediantime to recurrent biliary obstruction was not significantly different between the groups (p=0.46). In contrast, use of the 6-mm-diameterFCSEMS resulted in a significantly reduced incidence of stent-related adverse events (AEs) (p=0.016), especially cholecystitis(p=0.032), and patients aged <70 years were particularly affected by this significant reduction. Among the patients in the end-stage cohortwho were unable to continue chemotherapy after FCSEMS deployment, the free rate of stent-related events, including recurrentbiliary obstruction and stent-related AEs, was significantly higher in the 6-mm group (p=0.027). Conclusions: For UR-MDBO, a 6-mm-diameter FCSEMS can be an optimal and safe option in the younger cohort with a relativelyhigh risk of AEs and in the end-stage cohort requiring safer drainage without interference from stent-related events during times ofpoor prognosis.
Abstract
Background/Aims: To date, only thinner-diameter metal stents have been evaluated for unresectable malignant distal biliary obstruction(UR-MDBO). This study investigated the outcomes and optimal cohorts for a 6-mm-diameter fully covered self-expandable metalstent (FCSEMS) compared with those for a 10-mm-diameter FCSEMS. Methods: This single-center retrospective cohort study included patients who underwent initial transpapillary metal stenting forUR-MDBO. Propensity score matching (1:1) analysis was performed. Results: Of 133/68 patients who underwent 6-mm/10-mm-diameter FCSEMS deployment, 59 in each group were selected. The mediantime to recurrent biliary obstruction was not significantly different between the groups (p=0.46). In contrast, use of the 6-mm-diameterFCSEMS resulted in a significantly reduced incidence of stent-related adverse events (AEs) (p=0.016), especially cholecystitis(p=0.032), and patients aged <70 years were particularly affected by this significant reduction. Among the patients in the end-stage cohortwho were unable to continue chemotherapy after FCSEMS deployment, the free rate of stent-related events, including recurrentbiliary obstruction and stent-related AEs, was significantly higher in the 6-mm group (p=0.027). Conclusions: For UR-MDBO, a 6-mm-diameter FCSEMS can be an optimal and safe option in the younger cohort with a relativelyhigh risk of AEs and in the end-stage cohort requiring safer drainage without interference from stent-related events during times ofpoor prognosis.