Percutaneous Transhepatic Biliary Metal Stent For Malignant Hilar Obstruction: Results And Predictive Factors For Efficacy In 159 Patients From A Single Center

Aim: To investigate and compare the efficacy and safety of percutaneous transhepatic biliary stenting(PTBS) using a one- or two-stage procedure and determine the predictive factors for the efficacious treatment of malignant hilar obstruction(MHO).Methods: 159 consecutive patients with MHO who underwent PTBS were enrolled between January 2010 and June 2013. Patients were classified into one- or two-stage groups. Independent predictors of therapeutic success were evaluated using a logistic regression model.Results: 108 patients were treated with one-stage PTBS and 51 patients were treated with two-stage PTBS. The Stents were technically successful in all patients. Successful drainage was achieved in 114 patients(71.4%). A total of 42 early major complications were observed. Re-interventions were attempted in 23 patients during follow-up. The cumulative primary patency rates at 3, 6, and 12 months were 88%, 71%, and 48 %, respectively. Stent placement using a one- or two-stage procedure did not significantlyaffect therapeutic success, early major complications, median stent patency or survival. A stent placed across the duodenal papilla was an independent predictor of therapeutic success(odds ratio=0.262, 95% confidence interval [0.107–0.642]). Patients with stents across papilla had a lower rate of cholangitis compared with patients who had a stent above papilla(7.1% vs. 20.3%, respectively, p=0.03).Conclusions:The majority of patients with MHO who underwent one-stage PTBS showed similar efficacy and safety outcomes compared with those who underwent two-stage PTBS. Stent placement across the duodenal papilla was associated with a higher therapeutic success rate.