Percutaneous stent placement for malignant hilar biliary obstruction: a comparison between criss-cross and T-configuration techniques.

ABSTRACT

AIM: To compare the clinical effectiveness of percutaneous stent placement between T and criss-cross configuration techniques in patients with advanced malignant hilar biliary obstruction. MATERIALS AND METHODS: Between January 2009 and December 2014, 59 patients who underwent percutaneous stent placement for malignant hilar obstruction were included in this retrospective study. T-configured stent placement (T group) was performed in 33 patients and criss-cross configured stent placement (criss-cross group) in 26 patients. Technical and clinical success, complications, patient survival, and stent patency were compared between the two groups. RESULTS: Stent placement was technically successful in all patients of the two groups. Clinical success was achieved in 30 (90.9%) patients of T group and 25 (96.9%) of criss-cross group (p=0.62). Two patients in the T group (6.1%) required additional stent placement for internal drainage of undrained sector. There were no major complications. Median survival was not statistically different between the two groups (128 days in the T group versus 183 days in the criss-cross group; p=0.33). Stent occlusion occurred in 15 patients in the T group and seven patients in the criss-cross group. The stent patency of the criss-cross group (median 330 days) was longer than that of the T group (median 132 days; p=0.0007). CONCLUSIONS: Early clinical effectiveness is comparable between the two techniques; however, additional intervention is occasionally required for drainage of an undrained sector after T-configured stent placement. Stent placement with criss-cross configuration provides longer stent patency than T-configuration technique.