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Purpose <p>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.</p> Materials and methods <p>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 [&lt; 21&#xa0;μmol/L] or ≥ 50% reduction from baseline within 14&#xa0;days of initial drainage without biochemical rebound following catheter removal), complications, reintervention and mortality.</p> Results <p>After matching, 102 patients were analysed (51 TP, 51 SP). Technical and clinical success were comparable between groups (94.1 vs. 98.0% [<i>p</i> = 0.62] and 90.2 vs. 78.4% [<i>p</i> = 0.15], respectively). Complications occurred in 13.7% overall (17.6% TP vs. 9.8% SP [<i>p</i> = 0.39]). No significant differences were observed in the cumulative incidence of RBO (sHR 0.81, 95% CI 0.42–1.58 [<i>p</i> = 0.54]) or overall survival (HR 1.44, 95% CI 0.76–2.72 [<i>p</i> = 0.27]).</p> Conclusion <p>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.</p> Level of Evidence <p>2b, Cohort study.</p> Graphical Abstract <p></p>

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Outcomes of Suprapapillary Versus Transpapillary Biliary Stent Placement for Palliation of Malignant Hilar Biliary Obstruction

  • 期刊论文

  • 发表日期：

    2026年5月20日

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  • Frances Sheehan,
  • Ahmad Al-Rekabi,
  • Yiwang Xu,
  • Neeral Patel,
  • Wasim Hakim,
  • Paul Tait,
  • Alison Graham,
  • Ali Alsafi

摘要

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.

Graphical Abstract