Side-by-side versus stent-in-stent technique for stent deployment during systemic chemotherapy in biliary tract cancer patients with malignant hilar biliary obstruction.

Abstract

<h4>Objectives</h4>With the improved prognosis of patients with biliary tract cancer (BTC) owing to advances in chemotherapy, long-term stent patency has become an important goal in patients undergoing biliary stent placement. We compared the duration of stent patency between unresectable BTC patients undergoing multi-stenting for malignant hilar biliary obstruction by the side-by-side (SBS) and stent-in-stent (SIS) techniques during systemic chemotherapy.<h4>Methods</h4>We retrospectively evaluated the data of 62 unresectable BTC patients who underwent multi-stenting before the first or second cycle of first-line chemotherapy. Stent deployment was performed by the SBS technique in 40 patients (SBS group) and by the SIS technique in 22 patients (SIS group).<h4>Results</h4>The median time-to-recurrent biliary obstruction was 147 days in the SBS group and 252 days in the SIS (<i>p</i> = 0.029), being longer in the SIS group. The rates of development of early adverse events were 28% and 9% (<i>p</i> = 0.09) and the rates of development of late adverse events were 26% and 14% in the SBS and SIS groups (<i>p</i> = 0.27). The median overall survival was 480 days in the SBS group and 563 days in the SIS group (<i>p</i> = 0.92).<h4>Conclusion</h4>The duration of stent patency was shorter in the SBS group than in the SIS group; thus, the SIS technique is preferable to the SBS technique for biliary stent deployment in unresectable BTC patients during systemic chemotherapy.