Re‐intervention with 10‐mm vs 12‐mm covered self‐expandable metallic stent for recurrent unresectable distal biliary obstruction in patients with previous stent implantation

Background Treatment for unresectable distal malignant biliary obstruction (DMBO) involves placing a 10‐mm covered self‐expandable metallic stent (CSEMS). In recurrent biliary obstruction (RBO), replacement of the CSEMS is recommended; however, the appropriate stent type remains unknown. We speculated that large‐bore CSEMSs would provide longer patency. We compared the efficacy of 10‐mm and 12‐mm CSEMS in patients with RBO. Methods We retrospectively retrieved data on patients who underwent CSEMS replacement from the endoscopic database. We investigated the time to RBO (TRBO) after CSEMS replacement. The hazard ratio (HR) for the the second TRBO was estimated using the Cox proportional hazard model. The estimated median second TRBO was determined using the Kaplan‐Meier method. Results Among the 493 patients with DMBOs treated with 10‐mm CSEMS, 48 and 29 patients underwent re‐intervention with 10‐mm and 12‐mm CSEMS, respectively. The use of 12‐mm CSEMS was inversely associated with second TRBO (multivariable‐adjusted HR, 0.62; 95% CI, 0.39‐0.98; P = .042). The estimated median second TRBO was greater with the 12 mm CSEMS than with the 10 mm variety (562 days vs 207 days; P = .019). Conclusion The second intervention with 12‐mm CSEMS was associated with a longer TRBO. Chikugo and colleagues report on the first comparative study of 10‐mm and 12‐mm covered self‐expandable metallic stents (CSEMS) in terms of patency after replacement of the initial CSEMS in patients with recurrent biliary obstruction. They demonstrated that re‐intervention with the 12‐mm CSEMS resulted in longer patency than with the 10‐mm CSEMS.