Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Efficacy and safety of plastic and metal stents for endoscopic ultrasound guided-biliary drainage in elderly patients
Mitsuru Sugimoto, Yuki Nakajima, Yutaro Takeda, Yuki Sato, Tadayuki Takagi, Rei Suzuki, Hiroyuki Asama, Hiroshi Shimizu, Kentaro Sato, Rei Ohira, Jun Nakamura, Tsunetaka Kato, Takumi Yanagita, Mitsuru Otsuka, Takuto Hikichi, Hiromasa Ohira
Mitsuru Sugimoto, Yuki Sato, Tadayuki Takagi, Rei Suzuki, Hiroyuki Asama, Hiroshi Shimizu, Kentaro Sato, Rei Ohira, Takumi Yanagita, Mitsuru Otsuka, Department of Gastroenterology, Fukushima Medical University, Fukushima 960-1295, Japan
Yuki Nakajima, Department of Gastroenterology, Aizu Medical Center Fukushima Medical University, Aizuwakamatsu 969-3492, Fukushima, Japan
Yutaro Takeda, Department of Gastroenterology, Ohtanishinouchi General Hospital, Koriyama 963-8558, Japan
Jun Nakamura, Tsunetaka Kato, Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
Takuto Hikichi, Department of Endoscopy, Fukushima Medical University, Fukushima 960-1295, Japan
Hiromasa Ohira, Department of Gastroenterology, Fukushima Medical University, School of Medicine, Fukushima 960-1295, Japan
Author contributions: Sugimoto M wrote the paper and designed and performed the research; Nakajima Y, Takeda Y, and Sato Y performed the research; Takagi T, Suzuki R, Asama H, Shimizu H, Sato K, Ohira R, Nakamura J, Kato T, Yanagita T, and Otsuka M provided clinical advice; Hikichi T supervised the report; Ohira H supervised the reporting and writing of the paper. All authors approval the final manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of Fukushima Medical University (Approval No. 2399).
Informed consent statement: This study is retrospective. Informed consent was not necessary because the clinical data used in this study were anonymized. The need for consent to participate was also waived by the ethics committee.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets analyzed during the current study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Mitsuru Sugimoto, MD, PhD, Assistant Professor, Department of Gastroenterology, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan.
kitachuuou335@yahoo.co.jp
Received: June 4, 2025
Revised: June 28, 2025
Accepted: November 4, 2025
Published online: December 16, 2025
Processing time: 200 Days and 2.8 Hours
BACKGROUND
Endoscopic ultrasound (EUS)-guided biliary drainage (BD) is becoming more common as a secondary drainage method in cases of difficult endoscopic retrograde cholangiopancreatography. In a recent study, EUS-BD reportedly demonstrated similar safety between elderly patients and all other patients. However, the appropriate stent for placement in elderly patients is unknown.
AIM
To clarify whether a metallic stent (MS) or a plastic stent (PS) is suitable when performing EUS-BD in elderly patients.
METHODS
This was a multicenter retrospective study of patients who underwent EUS-BD between March 2005 and February 2025. The data of patients aged 70 years or older who underwent successful EUS-BD were analyzed, and the long-term outcomes of patients treated with an MS (MS group) and those treated with a PS (PS group) were compared.
RESULTS
Ninety-four patients underwent successful EUS-BD, of whom 64 were aged 70 years or older. The PS group included 51 patients, and the MS group included 13 patients. The time to recurrent biliary obstruction (TRBO) was not significantly different between the PS group and the MS group (6-month recurrent biliary obstruction rate 50.8% vs 26.8%, P = 0.18). When patients were limited to those with malignancies without antegrade stenting, the TRBO was significantly longer in the MS group than in the PS group (6-month recurrent biliary obstruction rate 63.3% vs 20.7%, P = 0.036).
CONCLUSION
A PS might be sufficient for performing EUS-BD in elderly patients aged 70 years or older with benign biliary disease because it is easily replaced. However, an MS might be more effective for elderly individuals with malignant biliary obstruction because of the expectation of a longer TRBO and a reduced need for stent replacement.
Core Tip: In a recent study, endoscopic ultrasound-guided biliary drainage reportedly demonstrated similar safety between elderly patients and all other patients. However, the appropriate stent for placement in elderly patients is unknown. This work reports that plastic stents are sufficient for patients with benign biliary diseases because they result in good outcomes and allow easier reintervention, whereas metallic stents are appropriate for older patients with malignancies because they offer better outcomes and a reduced physical burden of endoscopic reintervention.
