Comparison between Suprapapillary and Transpapillary Uncovered Self-Expandable Metallic Stent Placement for Perihilar Cholangiocarcinoma

Clinical question

How do suprapapillary and transpapillary uncovered self-expandable metallic stent placement compare for perihilar cholangiocarcinoma?

Take away point

Suprapapillary and transpapillary stent placement procedures were similar in terms of procedural success, occlusion rate, revision rate, postprocedural AEs, and 30-day mortality.

Reference

Borges AP, Silva AV, Donato P. Comparison between Suprapapillary and Transpapillary Uncovered Self-Expandable Metallic Stent Placement for Perihilar Cholangiocarcinoma. J Vasc Interv Radiol. 2023 Aug;34(8):1400-1408.

Click here for abstract

Study design

Retrospective, observational, descriptive study

Funding Source

None

Setting

Single academic center

Figure

A self-expanding metallic stent was placed with its lower margin (black arrow) above the level of the sphincter (white arrow).

Summary

A single-center retrospective study of 54 patients with inoperable perihilar cholangiocarcinoma who underwent percutaneous transhepatic biliary stent placement between January 1, 2019, and August 31, 2021, was conducted. According to stent location, the patients were classified into 2 groups: suprapapillary (S) and transpapillary (T). Demographic data, Bismuth-Corlette classification, type and location of the stent, laboratory data, postprocedural AEs, procedural success, stent occlusion, reintervention rate, and mortality were compared between the groups.

Stent placement was suprapapillary in 13 (24.1%) patients and transpapillary in 41 (75.9%) patients. Mean age was higher in Group T (78 vs 70.5 years; P = .046). Stent occlusion rates were similar in the 2 groups (Group S, 23.8%; Group T, 19.5%), as were AE rates, the most common being cholangitis (Group S, 23.1%; Group T, 24.4%). There were no significant differences in revision rate (Group S, 7.7%; Group T, 12.2%) and 30-day mortality rate (Group S, 15.4%; Group T, 19.5%). Ninety-day mortality rate was statistically significantly higher in Group T (46.3% vs 15.4%; P = .046). Preprocedural bilirubin level was higher in Group T, as were postprocedural leukocyte and C-reactive protein (CRP) levels.

Commentary

This study evaluates transpapillary biliary stenting versus suprapapillary stenting for cholangiocarcinoma. Both methods has theoretical benefits, but have not been directly compared. The authors did not find significant differences in outcomes or adverse events between the two groups. However, there was a small sample size, and there were significantly more patients in the transpapillary group (41) compared to the suprapapillary group (3). Incomplete follow up data also limits the detection of adverse events. Further studies of this topic with larger sample size and more consistent follow up are needed, but this study suggests that stent position may not matter as much as once thought.

Post author

Timothy Huber, MD
Jefferson Radiology
@IR_Huber