Comparison of antimigration versus conventional fully covered self-expandable metal stents for malignant distal biliary obstruction: a single-center long-term study.

BACKGROUND AND AIMS: Fully covered self-expandable metal stents (FCSEMSs) palliate distal malignant biliary obstruction (dMBO), but migration remains a limitation. We compared an antimigration stent (AMS) using finned FCSEMSs with a convention stent (CS) using flared FCSEMSs.

METHODS

A retrospective cohort (April 2020-2024) of adults with unresectable dMBO undergoing ERCP with AMS or CS was analyzed. Primary outcomes were stent migration and recurrent biliary obstruction (RBO). Time-to-event outcomes were analyzed using inverse probability of treatment weighting (IPTW) Cox models, with propensity score matching (PSM) for sensitivity.

RESULTS

Among 276 patients (CS, 172; AMS, 104), crude migration was lower with AMS (0.96% vs 7.6%; P = .02). After IPTW adjustment, migration risk remained directionally lower but was not statistically significant (hazard ratio, 0.23; 95% CI, 0.03-1.80; P = .16). Migration remained numerically lower after PSM (P = .10). RBO risk was similar between groups.

CONCLUSIONS

Antimigration FCSEMSs demonstrated lower crude migration with similar patency (RBO risk), but adjusted analyses did not reach statistical significance.