Comparative analysis of repeated retrograde mono - and bistentation in malignant stricture of the terminal choledochus and dysfunction of an uncovered self-expanding metal stent

Background. At present, the issue of choosing the type of biliary stent in obstructions of the terminal part of the common bile duct of malignant origin has been studied quite well, however, the issue of choosing a stent in case of dysfunctions of previously installed stents has practically not been studied.

Study purpose. The aim of the study was to compare mono- and parallel bistenting with plastic stents in case of dysfunction of an uncoated self-expanding stent placed for the purpose of decompression in case of obstruction of the terminal part of the common bile duct of malignant origin.

Study material and methods. The main group included 30 patients who received 2 parallel stent-to-stent stents during restentation, the control group consisted of 52 patients with 1 stent-to-stent plastic stent installed during restentation.

Outcomes: The advantage of the main group in comparison with the control group was statistically significant in terms of the rate of decrease in postoperative leukocytosis, direct bilirubin and common bile duct diameter. No statistically significant advantage of the control group in comparison with the main group was found for any of the studied parameters.

Conclusions. Preliminary conclusions can be drawn about the advantage of using the parallel bistening method with plastic stents compared to monostenting in the treatment of obstructive jaundice with dysfunction of a previously installed uncoated self-expanding metal stent.

1. Iwasaki A., Kubota K., Kurita Y. et al. The placement of multiple plastic stents still has important roles in candidates for chemotherapy for unresectable perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci., 2020, Oct; № 27(10), рр. 700–711. https://doi.org/10.1002/jhbp.804

2. Radwana M., Emarab M., Zaghloulb M. et al. Double plastic stenting for inoperable malignant biliary stricture among cirrhotic patients as a possible cost-effective treatment: a pilot study. European Journal of Gastroenterology & Hepatology, 2019, № 31, рр. 1057–1063. https://doi.org/10.1097/ MEG.000000000000142

3. Dumonceau J., Tringali A., Papanikolaou I. et al. Endoscopic biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical Guideline – Updated October 2017. Endoscopy, 2018, № 50, рр. 910–930. https://doi.org/10.1055/a-0659-9864

4. Moole H., Jaeger A., Cashman M. et al. Are self-expandable metal stents superior to plastic stents in palliating malignant distal biliary strictures? A meta-analysis and systematic review. Medical Journal Armed Forces India, 2017, № 73(1), рр. 42–48. http://dx.doi.org/10.1016/j. mjafi.2016.08.014

5. Pu L., Hourneaux de Moura E., Bernardo W. et al. Endoscopic stenting for inoperable malignant biliary obstruction: A systematic review and meta-analysis. World J Gastroenterol, 2015, December 21, № 21(47), рр. 13374–13385. https://doi.org/10.3748/wjg.v21.i47.13374

6. Hong W., Chen X., Wu W. et al. Metal versus plastic stents for malignant biliary obstruction: An update meta-analysis. Clinics and Research in Hepatology and Gastroenterology, 2013, № 37(5), рр. 496–500. https://doi. org/10.1016/j.clinre.2012.12.002

7. Almadi M., Barkun., Martel M. Plastic vs. Self-Expandable Metal Stents for Palliation in Malignant Biliary Obstruction: A Series of MetaAnalyses. American Journal of Gastroenterology, 2017, № 112(2), рр. 260– 273. https://doi.org/10.1038/ajg.2016.512

8. Sawas T., Al Halabi Sh., Parsi M. et al. Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis. Gastrointestinal Endoscopy, 2015, № 82(2), рр. 256–267. https://doi. org/10.1016/j.gie.2015.03.1980

9. Lawrence C. and Romagnuolo J. Double Plastic Stents for Distal Malignant Biliary Obstruction: Preliminary Evidence for a Novel Cost-Effective Alternative to Metal Stenting. The American Journal of Gastroenterology, 2014, № 109, рр. 295–297. https://doi.org/10.1038/ajg.2013.409

10. Cabral J., Taglieri E., Pelosof A. et al. Comparative Study between Plastic and Metallic Stents for Biliary Decompression in Patients with Distal Biliary Obstruction. Gastroenterology Research and Practice, 2017, Volume 2017. https://doi.org/10.1155/2017/7621821

11. Walter D., van Boeckel P., Groenen M. et al. Cost Efficacy of Metal Stents for Palliation of Extrahepatic Bile Duct Obstruction in a Randomized Controlled Trial. Gastroenterology, 2015, № 149(1), рр. 130–138. https://doi.org/10.1053/j.gastro.2015.03.012

12. Shah T., Desai S., Haque M. et al. Management of occluded metal stents in malignant biliary obstruction: similar outcomes with second metal stents compared to plastic stents. Dig Dis Sci., 2012, № 57(11), рр. 2765– 2773. https://doi.org/10.1007/s10620-012-2272-7