Potential of 6-mm-diameter fully covered self-expandable metal stents for unresectable malignant distal biliary obstruction: a propensity score-matched study
- Author:
Daiki YAMASHIGE
1
;
Susumu HIJIOKA
;
Yoshikuni NAGASHIO
;
Yuta MARUKI
;
Soma FUKUDA
;
Shin YAGI
;
Kohei OKAMOTO
;
Hidenobu HARA
;
Yuya HAGIWARA
;
Daiki AGARIE
;
Tetsuro TAKASAKI
;
Akihiro OHBA
;
Shunsuke KONDO
;
Chigusa MORIZANE
;
Hideki UENO
;
Miyuki SONE
;
Yutaka SAITO
;
Takuji OKUSAKA
Author Information
- Publication Type:Original Article
- From:Clinical Endoscopy 2025;58(1):121-133
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background/Aims:To date, only thinner-diameter metal stents have been evaluated for unresectable malignant distal biliary obstruction (UR-MDBO). This study investigated the outcomes and optimal cohorts for a 6-mm-diameter fully covered self-expandable metal stent (FCSEMS) compared with those for a 10-mm-diameter FCSEMS.
Methods:This single-center retrospective cohort study included patients who underwent initial transpapillary metal stenting for UR-MDBO. Propensity score matching (1:1) analysis was performed.
Results:Of 133/68 patients who underwent 6-mm/10-mm-diameter FCSEMS deployment, 59 in each group were selected. The median time to recurrent biliary obstruction was not significantly different between the groups (p=0.46). In contrast, use of the 6-mm-diameter FCSEMS resulted in a significantly reduced incidence of stent-related adverse events (AEs) (p=0.016), especially cholecystitis (p=0.032), and patients aged <70 years were particularly affected by this significant reduction. Among the patients in the end-stage cohort who were unable to continue chemotherapy after FCSEMS deployment, the free rate of stent-related events, including recurrent biliary obstruction and stent-related AEs, was significantly higher in the 6-mm group (p=0.027).
Conclusions:For UR-MDBO, a 6-mm-diameter FCSEMS can be an optimal and safe option in the younger cohort with a relatively high risk of AEs and in the end-stage cohort requiring safer drainage without interference from stent-related events during times of poor prognosis.
