Clin Endosc.  2025 Jan;58(1):121-133. 10.5946/ce.2024.044.

Potential of 6-mm-diameter fully covered self-expandable metal stents for unresectable malignant distal biliary obstruction: a propensity score-matched study

• Yamashige D
• Hijioka S
• Nagashio Y
• Maruki Y
• Fukuda S
• Yagi S
• Okamoto K
• Hara H
• Hagiwara Y
• Agarie D
• Takasaki T
• Ohba A
• Kondo S
• Morizane C
• Ueno H
• Sone M
• Saito Y
• Okusaka T

• KMID: 2564026
• DOI: http://doi.org/10.5946/ce.2024.044

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 metal stent (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 for UR-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 median time to recurrent biliary obstruction was not significantly different between the groups (p=0.46). In contrast, use of the 6-mm-diameter FCSEMS 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 cohort who were unable to continue chemotherapy after FCSEMS deployment, the free rate of stent-related events, including recurrent biliary 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 relatively high risk of AEs and in the end-stage cohort requiring safer drainage without interference from stent-related events during times of poor prognosis.

Keyword

Adverse event; Cholecystitis; Malignant biliary obstruction; Metal stent; Thinner-diameter stent