Post written by Mitsuru Okuno, MD, PhD, from the Department of Gastroenterology, Gifu University Municipal Hospital, Gifu, Japan.

Intraductal plastic stent (IS) placement has been known to have long stent patency. However, the effectiveness of bilateral IS placement compared with bilateral self-expandable metal stent (SEMS) placement—including stent patency, adverse events, and endoscopic reintervention—in patients with unresectable malignant hilar biliary obstruction (UMHBO) is unclear.

This study aimed to evaluate the effectiveness of bilateral IS placement compared with bilateral SEMS placement using propensity score matching. It was important to conduct this study because we did not know the usefulness of bilateral IS placement and thought that if it was useful, it might change the strategy for stent selection in UMHBO.

To the best of our knowledge, this study is the first to compare IS and SEMS placement in UMHBO, including adverse events and reintervention. Bilateral IS placement can be considered a good option for UHMBO drainage because IS placement can reduce ERCP procedure time.

In addition, ISs are easy to place and remove in reintervention, and they have sufficient stent patency after initial placement and reintervention compared with bilateral SEMS placement.

A, Kaplan-Meier curve showing the time to recurrent biliary obstruction (TRBO) in the intraductal plastic stent (IS) and self-expandable metal stent (SEMS) group. No significant difference was found between both groups in median TRBO (P = .47 by log-rank test). B, Kaplan-Meier curve showing the time to patient death in the IS and SEMS groups. No significant difference was found between both groups in median overall survival (P = .94 by log-rank test).

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