A recently published retrospective study in the Journal of Vascular and Interventional Radiology has found no significant differences in suprapapillary and transpapillary stent placement for perihilar cholangiocarcinoma (CCA) in terms of occlusion rate, procedure success, postprocedure adverse events (AE), revision rate, and 30-day mortality.
The study found that the transpapillary group had a higher 90-day mortality rate and post-procedure WBC levels, even though the patients in this group were older and had higher pre-procedure bilirubin levels.
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The researchers assessed 54 patients with inoperable perihilar CCA who underwent percutaneous transhepatic biliary stenting between January 1, 2019, and August 31, 2021. The patients were all from a single center. The study team divided patients into transpapillary (T) or suprapapillary (S) cohorts, according to the stent location.
Multiple parameters, including reintervention rate, mortality, demographic information, Bismuth-Corlette classification, the type and location of the stent, laboratory data, procedure success, postprocedure AE, and stent occlusion, were compared between the 2 groups.
Study results showed that 13 patients (24.1%) had suprapapillary stent placement while 41 (75.9%) had transpapillary. Mean age was 78 years in the T cohort and 70.5 years in the S cohort. The stent occlusion and AE rates were comparable in both study arms, with cholangitis being the most common.
Furthermore, no significant differences were reported in the revision rate nor in the 30-day mortality rate. The results also revealed that the 90-day mortality rate was statistically significantly higher in the T group compared to the S group.
In addition, the pre-procedure bilirubin level was higher in the T group, similar to the reactive C-protein levels and postprocedure leucocyte.
“The decision to place stents supra vs transpapillary was not based on a systematic protocol and may have been influenced by the perception of extent of disease,” the authors wrote.
CCA comprises a heterogeneous group of severe and rare malignant tumors originating from biliary tree cells. This disease is usually diagnosed in advanced stages, with a poor prognosis. CCA is the second most common primary hepatic malignancy, with an incidence rate of 0.3 to 6 per 100,000 per year.
Perihilar CCA is the most common type, with typical diagnostic imaging findings including wall thickening, bile duct dilatation, intraductal or periductal infiltrative ill-defined lesions with delayed enhancement, and occasionally lobar/segmental atrophy. Endoscopic stent placement is less painful than percutaneous placement but has a higher incidence of cholangitis and a lower success rate in proximal hilar obstructions. Inserting the stent above the papilla can reduce stent-related adverse events and provide longer stent patency by preventing reflux of duodenal contents.
Borges AP, Silva AV, Donato P, et al. Comparison between suprapapillary and transpapillary uncovered self-expandable metallic stent placement for perihilar cholangiocarcinoma. J Vasc Interv Radiol. Published online April 4, 2023. doi: 10.1016/j.jvir.2023.03.031