Comparison of Uncovered Stent Placement across versus above the Main Duodenal Papilla for Malignant Biliary Obstruction

Purpose: To evaluate the differences in efficiency and complications of metal stent insertion across versus above the main duodenal papilla (MDP) in patients with malignant obstruction of the common bile duct (CBD). Materials and Methods: Records of 98 consecutive patients who underwent stent insertion for malignant CBD obstruction between 2004 and 2010 were retrospectively reviewed. Fifty-one patients (group 1) and 47 patients (group 2), were treated with stent insertion across and above the MDP, respectively. Primary stein patency, overall survival, complications, and changes in serum bilirubin level following stein insertion were assessed. Results: Infection appeared in 12 and four patients, respectively, in groups 1 and 2. The respective mean primary stent patency times were 307.8 days +/- 20.2 and 490.7 days +/- 40.7, and mean survival times were 245.1 days +/- 17.4 and 286.3 days +/- 20.2. Bilirubin reduction rates were 55.7% +/- 16.6 and 61.1% +/- 13.7 at 1 week and 84.2% +/- 5.7 and 86.2% +/- 5.7 at 1 month in groups 1 and 2, respectively. In group 2, the rate of infection was significantly lower (P = .044) and primary stent patency was longer (P = .019). However, there was no significant difference between groups in survival time (P = .074) or bilirubin reduction rate at 1 week (P = .083) or 1 month (P = .082). Conclusions: Bile stent insertion above the MDP May achieve longer stent patency and a lower infection rate compared with placement across the MDP. For patients with malignant CBD obstruction, biliary stents should be placed above the papilla if papillary lesions are not invaded.