Cardiovascular and interventional radiology · 2026
Outcomes of Suprapapillary Versus Transpapillary Biliary Stent Placement for Palliation of Malignant Hilar Biliary Obstruction.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Sheehan Frances, Al-Rekabi Ahmad, Xu Yiwang, Patel Neeral, Hakim Wasim, Tait Paul, Graham Alison, Alsafi Ali
Аннотация
PURPOSE: The optimal distal position of percutaneously deployed self-expanding metal stents (SEMS) in malignant hilar biliary obstruction (MHBO) is debated. This study compared the safety and effectiveness of suprapapillary (SP) versus transpapillary (TP) SEMS placement in isolated MHBO.
MATERIALS AND METHODS: Eligible adult patients undergoing percutaneous uncovered biliary SEMS placement for isolated MHBO at a single centre (2011-2024) were retrospectively identified. Stent position was classified as SP or TP based on blinded imaging review. Propensity score matching minimised baseline differences between groups. The primary outcome was the incidence of recurrent biliary obstruction (RBO). Secondary outcomes included technical success, clinical success (bilirubin normalisation [< 21 μmol/L] or ≥ 50% reduction from baseline within 14 days of initial drainage without biochemical rebound following catheter removal), complications, reintervention and mortality.
RESULTS: After matching, 102 patients were analysed (51 TP, 51 SP). Technical and clinical success were comparable between groups (94.1 vs. 98.0% [p = 0.62] and 90.2 vs. 78.4% [p = 0.15], respectively). Complications occurred in 13.7% overall (17.6% TP vs. 9.8% SP [p = 0.39]). No significant differences were observed in the cumulative incidence of RBO (sHR 0.81, 95% CI 0.42-1.58 [p = 0.54]) or overall survival (HR 1.44, 95% CI 0.76-2.72 [p = 0.27]).
CONCLUSION: No significant differences were observed between SP and TP stent positions for isolated MHBO. When SP placement is intra-procedurally identified to be suboptimal, a TP strategy does not compromise biliary patency or survival. This supports an individualised approach to managing complex hilar disease.
LEVEL OF EVIDENCE: 2b, Cohort study.
MATERIALS AND METHODS: Eligible adult patients undergoing percutaneous uncovered biliary SEMS placement for isolated MHBO at a single centre (2011-2024) were retrospectively identified. Stent position was classified as SP or TP based on blinded imaging review. Propensity score matching minimised baseline differences between groups. The primary outcome was the incidence of recurrent biliary obstruction (RBO). Secondary outcomes included technical success, clinical success (bilirubin normalisation [< 21 μmol/L] or ≥ 50% reduction from baseline within 14 days of initial drainage without biochemical rebound following catheter removal), complications, reintervention and mortality.
RESULTS: After matching, 102 patients were analysed (51 TP, 51 SP). Technical and clinical success were comparable between groups (94.1 vs. 98.0% [p = 0.62] and 90.2 vs. 78.4% [p = 0.15], respectively). Complications occurred in 13.7% overall (17.6% TP vs. 9.8% SP [p = 0.39]). No significant differences were observed in the cumulative incidence of RBO (sHR 0.81, 95% CI 0.42-1.58 [p = 0.54]) or overall survival (HR 1.44, 95% CI 0.76-2.72 [p = 0.27]).
CONCLUSION: No significant differences were observed between SP and TP stent positions for isolated MHBO. When SP placement is intra-procedurally identified to be suboptimal, a TP strategy does not compromise biliary patency or survival. This supports an individualised approach to managing complex hilar disease.
LEVEL OF EVIDENCE: 2b, Cohort study.