Guilmoteau T, Rouquette O, Buisson A, Cambier S, Abergel A, Poincloux L. Direct comparison of simultaneous and sequential endoscopic metallic bilateral stenting in malignant hilar biliary obstruction. World J Gastroenterol 2025; 31(19): 101913 [PMID: 40497097 DOI: 10.3748/wjg.v31.i19.101913]
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07768223
Submitted on:
August 09, 2025, 20:46
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Reader Comments:
This study by Guilmoteau et al shows that the relatively newer endoscopic technique of simultaneous stent-beside-stent strategy for malignant hilar biliary obstruction has higher technical success rate when compared to sequential stent-beside-stent technique, and a similar technical success rate to sequential stent-inside-stent technique. Interestingly, there was no significant difference in clinical success or adverse events between these three groups, and the risk of recurrent biliary obstruction was not significant between the simultaneous and sequential groups. The study states that technical failure is associated with a higher rate of fatal cholangitis; however, the P value provided is 0.085 with the CI crossing 1 (CI 0.78-44.4) so this finding is not statistically significant. A valuable addition to this study would be to evaluate the rates of improvement in radiographic biliary dilatation between these three strategies, and if improvement in biliary dilatation was achieved bilaterally or unilaterally. Nevertheless, this is an interesting study which shows that simultaneous stent-beside-stent management of malignant hilar biliary obstruction may be favored over the sequential stent-beside-stent strategy as the former strategy has higher technical success rates.
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