Feasibility of one-step endoscopic metal stenting for distal malignant biliary obstruction

BackgroundWe aimed to clarify the clinical usefulness of one-step self-expandable metal stent (SEMS) placement for distal malignant biliary obstruction by comparing with two-step SEMS placement. MethodsWe retrospectively compared early complications, bilirubin level decreasing rate, and period of hospitalization between 40 patients with one-step SEMS and 52 patients with two-step SEMS. We also evaluated the complications in patients with two-step SEMS by classifying them into first drainage (ERBD or ENBD) and second drainage (SEMS). ResultsThe total incidence of early complications was significantly higher in patients with one-step SEMS than the second drainage of two-step SEMS (42.5% [17/40] vs. 13.5% [7/52]; P=0.004). However, there was no significant difference in the early complications between one-step SEMS and two-step SEMS (total of first and second drainage) (42.5% [17/40] vs. 36.5% [19/52]; P=0.561). The period required to reach the bilirubin level (<3mg/dL) after initial drainage was significantly shorter in one-step SEMS than in two-step SEMS (5.7 vs. 10.1 days; P=0.025). Similar results were observed in the period of hospitalization for patients without chemotherapy (22.2 vs. 37.3 days; P=0.004). ConclusionsOne-step SEMS placement is the alternative option of drainage method for distal malignant biliary obstruction.