Suprapapillary versus transpapillary stent placement for malignant biliary obstruction: which is better?

Abstract

Purpose: To compare the complications, stent patency, and patient survival with self-expandable metal stents (SEMSs) placed above or across the sphincter of Oddi in malignant biliary obstruction.

Materials and methods: From January 2008 to December 2012, 155 patients were treated with percutaneous transhepatic SEMS placement. Seventy-four patients underwent suprapapillary stent placement (group A), and 81 patients underwent transpapillary stent placement (group B). Complications rates, stent patency, and patient survival were evaluated and analyzed for potential predictors.

Results: In group A, 68 covered and 28 uncovered SEMSs were placed, and, in group B, 78 covered and 19 uncovered SEMSs were placed. Thirty-six stent-related early complications were observed in a total of 154 patients (23.4%): pancreatitis (n = 23), cholangitis (n = 12), and cholecystitis (n = 1). The early complication rates for groups A and B were 14.9% (11 of 74) and 31.3% (25 of 80), respectively (P = .016). Pancreatitis occurred in three patients (4.1%) in group A and 20 patients (25.0%) in group B (P = .001). Stent location was a single independent predictor of pancreatitis (P < .001). Stent occlusions by tumor growth was more frequently observed in group A than in group B (P = .007), whereas stent occlusion by sludge incrustation was more frequently found in group B than in group A (P = .007). There was no significant difference in cumulative stent patency (P = .401) or patient survival (P = .792) between groups.

Conclusions: To decrease the incidence of pancreatitis, suprapapillary placement of SEMSs is recommended for malignant biliary obstruction, but not in the lower 2 cm of the common bile duct.