Management of unresectable hilar biliary obstruction : Plastic stents versus metallic stents and unilateral versus bilateral biliary drainage

Background and aim: Consensus regarding stenting for hilar biliary obstruction has not yet been established. The aim of this study was to compare the patency of plastic stents (PS) and metallic stents (MS), and to determine the ideal management for hilar biliary obstruction. Patients and methods: We retrospectively reviewed 126 patients with unresectable, malignant hilar / upper biliary obstruction treated with placement of plastic stent (PS, 19 patients), bared metallic stent (bMS, 98 patients), or covered metallic stent (cMS, 9 patients) and compared their the survival period, duration of stent patency and complications. We also compared patients who underwent unilateral biliary drainage (unilateral group, 50 patients) with those who underwent bilateral biliary drainage (bilateral group, 17 patients) for biliary obstruction. Results: Median survival time, cumulative patency duration, and median event-free survival time were all longer in the bMS group than in the PS group (p<0.01). There was no significant difference in them between the unilateral group and bilateral group. Liver abscess was observed at a higher frequency in the bilateral group (17.6%) than in the unilateral group (2%) (P<0.05). Conclusions: Unilateral placement of bMS is recommended for patients with malignant biliary obstruction, and bilateral biliary drainage is only indicated for patients who developed contralateral cholangitis or those with poor relief of jaundice.

hilar biliary obstruction

unilateral biliary drainage

bilateral biliary drainage

plastic stents

metallic stents