This preprint is under consideration at BMC Gastroenterology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Percutaneous stent placement for malignant hilar biliary obstruction: side-by-side versus stent-in-stent technique
Hai-bin Shi
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Currently, side-by-side (SBS) and stent-in-stent (SIS) are the two main techniques for stent deployment to treat hilar biliary obstructions. Previous studies comparing these two techniques are very limited, and thus, no consensus has been reached on which technique is better. The purpose of this study is to compare the clinical efficacy and safety of SBS and SIS deployment via a percutaneous approach for malignant hilar biliary obstruction.
Methods: From July 2012 to April 2019, 65 patients with malignant hilar biliary obstruction who underwent bilateral stenting using either the SBS or SIS techniques were included in this study. Among them, 27 patients underwent SIS stent insertion (SIS group), and the remaining 38 patients underwent SBS stent insertion (SBS group). Technical success, improvement of jaundice, complications, duration of stent patency, and overall survival were evaluated.
Results: Technical success was achieved in all patients in the two groups. The serum bilirubin level decreased more rapidly 1 week after the procedures in the SBS group than in the SIS group (P=0.02). Although the total complication rate did not differ between the two groups, cholangitis was found to be more frequent in the SIS group (P=0.04). The median stent patency was significantly longer in the SBS group (149 days) than in the SIS group (75 days; P=0.02). The median overall survival did not significantly differ between the two groups (SBS vs. SIS, 155 days vs. 143 days; P>0.05).
Conclusions: Percutaneous transhepatic bilateral stenting using either the SBS or SIS technique is safe and effective in the management of malignant hilar biliary obstruction. However, SBS offers a quicker improvement of jaundice, a lower incidence of cholangitis after the procedure, and a longer stent patency period than SIS.
Keywords
Hilar biliary obstruction; bilateral stenting; jaundice; stent patency.
Figure 1
Figure 2
Figure 3
Figure 4
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 3
Posted 28 May, 2020
No community comments so far
Editor assigned
On 18 May, 2020
Submission checks complete
On 17 May, 2020
Editor invited
On 17 May, 2020
No comments provided
Editorial decision: Minor revision
On 10 May, 2020
Review #2 received
Received 07 May, 2020
Review #1 received
Received 18 Apr, 2020
Reviewer #2 agreed
On 09 Apr, 2020
Reviewers invited
Invitations sent on 31 Mar, 2020
Reviewer #1 agreed
On 31 Mar, 2020
Editor assigned
On 29 Mar, 2020
Submission checks complete
On 28 Mar, 2020
Editor invited
On 28 Mar, 2020
No comments provided
Editorial decision: Minor revision
On 17 Mar, 2020
Review #1 received
Received 15 Mar, 2020
Review #2 received
Received 06 Mar, 2020
Reviewer #2 agreed
On 01 Mar, 2020
Editor assigned
On 29 Feb, 2020
Reviewers invited
Invitations sent on 29 Feb, 2020
Reviewer #1 agreed
On 29 Feb, 2020
Submission checks complete
On 25 Feb, 2020
Editor invited
On 24 Feb, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Gastroenterology & Hepatology
Learn more about our company.
This preprint is under consideration at BMC Gastroenterology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Percutaneous stent placement for malignant hilar biliary obstruction: side-by-side versus stent-in-stent technique
Hai-bin Shi
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 3
Posted 28 May, 2020
No community comments so far
Editor assigned
On 18 May, 2020
Submission checks complete
On 17 May, 2020
Editor invited
On 17 May, 2020
No comments provided
Editorial decision: Minor revision
On 10 May, 2020
Review #2 received
Received 07 May, 2020
Review #1 received
Received 18 Apr, 2020
Reviewer #2 agreed
On 09 Apr, 2020
Reviewers invited
Invitations sent on 31 Mar, 2020
Reviewer #1 agreed
On 31 Mar, 2020
Editor assigned
On 29 Mar, 2020
Submission checks complete
On 28 Mar, 2020
Editor invited
On 28 Mar, 2020
No comments provided
Editorial decision: Minor revision
On 17 Mar, 2020
Review #1 received
Received 15 Mar, 2020
Review #2 received
Received 06 Mar, 2020
Reviewer #2 agreed
On 01 Mar, 2020
Editor assigned
On 29 Feb, 2020
Reviewers invited
Invitations sent on 29 Feb, 2020
Reviewer #1 agreed
On 29 Feb, 2020
Submission checks complete
On 25 Feb, 2020
Editor invited
On 24 Feb, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Gastroenterology & Hepatology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Currently, side-by-side (SBS) and stent-in-stent (SIS) are the two main techniques for stent deployment to treat hilar biliary obstructions. Previous studies comparing these two techniques are very limited, and thus, no consensus has been reached on which technique is better. The purpose of this study is to compare the clinical efficacy and safety of SBS and SIS deployment via a percutaneous approach for malignant hilar biliary obstruction.
Methods: From July 2012 to April 2019, 65 patients with malignant hilar biliary obstruction who underwent bilateral stenting using either the SBS or SIS techniques were included in this study. Among them, 27 patients underwent SIS stent insertion (SIS group), and the remaining 38 patients underwent SBS stent insertion (SBS group). Technical success, improvement of jaundice, complications, duration of stent patency, and overall survival were evaluated.
Results: Technical success was achieved in all patients in the two groups. The serum bilirubin level decreased more rapidly 1 week after the procedures in the SBS group than in the SIS group (P=0.02). Although the total complication rate did not differ between the two groups, cholangitis was found to be more frequent in the SIS group (P=0.04). The median stent patency was significantly longer in the SBS group (149 days) than in the SIS group (75 days; P=0.02). The median overall survival did not significantly differ between the two groups (SBS vs. SIS, 155 days vs. 143 days; P>0.05).
Conclusions: Percutaneous transhepatic bilateral stenting using either the SBS or SIS technique is safe and effective in the management of malignant hilar biliary obstruction. However, SBS offers a quicker improvement of jaundice, a lower incidence of cholangitis after the procedure, and a longer stent patency period than SIS.
Figure 1
Figure 2
Figure 3
Figure 4