Percutaneous Stent Placement for Malignant Hilar Biliary Obstruction: A Comparison between T- and Crisscross-configuration Techniques

Abstract

Introduction: To compare the clinical efficacy of percutaneous stent placement between T- and crisscross-configuration techniques in patients with advanced malignant hilar biliary obstruction.

Methods: Between April 2006 and December 2013, 51 patients (mean 69.0 years, range 47–88 years) who underwent percutaneous stent placement for malignant hilar obstruction were included in this retrospective study. T-configured stent placement (T group) was performed in 30 patients and crisscross-configured stent placement (crisscross group) in 21 patients. Technical and clinical success, complications, stent patency, and patient survival were compared between the two groups.

Results: Stent placement was technically successful in all patients of the two groups. Hemobilia caused by tumor bleeding was observed in two patients of T group (6.7%, p = .341). Clinical success was achieved in 25 (83.3%) patients of T group and 18 (85.7%) of crisscross group (p = .570). During follow-up period (20–541 days [median, 112 days]), stent occlusion occurred in 14 (56.0%, 14 of 25) of the patients in T group and 4 (22.2%, 4 of 18) of the patients in crisscross group (p = .027). Additionally, re-intervention was required for initially undrained hepatic section in 4 patients of T group (p = .103). Stent patency of crisscross group (median 315 days) was longer than that of T group (median 157 days) (p = .047).

Conclusions: Early clinical effectiveness is comparable between the two techniques. However, crisscross-configured stent placement was better than T-configuration providing longer stent patency and less requirement of re-intervention.