Risk Factors Associated with Recurrent Biliary Obstruction After Endoscopic Bilioduodenal Double Stenting.

OBJECTIVE

Endoscopic bilioduodenal double stenting is sometimes necessary for patients with malignant bilioduodenal obstruction (MBDO). The patency of biliary stents is important for preventing cholangitis and continuing treatment. However, the factors that influence recurrent biliary obstruction (RBO) in patients with MBDO are not well known. This study aimed to identify the factors associated with RBO in patients who underwent endoscopic bilioduodenal double stenting.

METHODS

Patient characteristics, device use, and endoscopic treatment procedures were evaluated as possible risk factors for RBO.

RESULTS

Overall, 55 patients with MBDO underwent endoscopic bilioduodenal double stenting (transpapillary drainage, n = 35; endoscopic ultrasound-guided biliary drainage, n = 20). Multivariate analysis using a Fine and Gray competing risk model revealed that biliary stenting on the oral side of the duodenal stricture (HR 2.98; 95% CI 1.16-7.68; p = 0.023) and chemotherapy (HR 3.74; 95% CI 1.25-11.22; p = 0.018) were significantly associated with RBO.

CONCLUSION

Biliary stenting on the oral side of the duodenal stricture was associated with RBO during duodenal stenting in patients with MBDO. Although chemotherapy was also associated with RBO in the multivariable competing risk analysis, this finding should be interpreted cautiously. Careful treatment selection, including consideration of gastrojejunostomy in patients with oral-side biliary stenting, may help reduce the incidence of RBO.