Pietrzak J, Pertkiewicz J, Kozieł S, Babski P, Ligocka J, Przybyłkowski A. Endoscopic treatment of malignant hilar biliary obstruction: A retrospective cohort study. World J Gastrointest Endosc 2025; 17(12): 110432 [DOI: 10.4253/wjge.v17.i12.110432]
Corresponding Author of This Article
Adam Przybyłkowski, Full Professor, Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, 1a Banacha Street, Warsaw 02-091, Mazowieckie, Poland. aprzybylkowski@wum.edu.pl
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Dec 16, 2025; 17(12): 110432 Published online Dec 16, 2025. doi: 10.4253/wjge.v17.i12.110432
Endoscopic treatment of malignant hilar biliary obstruction: A retrospective cohort study
Jakub Pietrzak, Jan Pertkiewicz, Sławomir Kozieł, Paweł Babski, Joanna Ligocka, Adam Przybyłkowski
Jakub Pietrzak, Jan Pertkiewicz, Sławomir Kozieł, Paweł Babski, Joanna Ligocka, Adam Przybyłkowski, Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, Warsaw 02-091, Mazowieckie, Poland
Author contributions: Pietrzak J conceived the study and designed the methodology; Pietrzak J, Ligocka J, Pertkiewicz J, Kozieł S, and Babski P performed the endoscopic procedures; Pietrzak J collected and analyzed the data and drafted the manuscript; Przybyłkowski A conducted the critical review and revised the manuscript; all authors participated in the final review, approved the manuscript, and ensured the accuracy and integrity of the work.
Institutional review board statement: The study was submitted to the Bioethics Committee of the Medical University of Warsaw, which confirmed that formal approval was not required due to the retrospective design and full anonymization of patient data. The study was conducted in accordance with institutional and national ethical standards and with the 1964 Helsinki Declaration and its later amendments.
Informed consent statement: Informed consent was waived due to the retrospective nature of the study and the use of fully anonymized data, as approved by the institutional bioethics committee.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this study. No financial or non-financial support from any commercial entity was received.
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 anonymized datasets used and 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: Adam Przybyłkowski, Full Professor, Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, 1a Banacha Street, Warsaw 02-091, Mazowieckie, Poland. aprzybylkowski@wum.edu.pl
Received: June 7, 2025 Revised: July 12, 2025 Accepted: October 17, 2025 Published online: December 16, 2025 Processing time: 193 Days and 9.3 Hours
Abstract
BACKGROUND
Endoscopic biliary drainage for malignant hilar biliary obstruction (MHBO) remains a highly complex endoscopic retrograde cholangiopancreatography (ERCP) procedure. Each case requires an individualized approach, with outcomes influenced by the expertise of the medical center and access to advanced endoscopic tools.
AIM
To compare different stent types and drainage strategies, including the use of adjunctive therapies, in patients with MHBO treated endoscopically.
METHODS
We retrospectively analyzed 164 patients with MHBO (Bismuth types 3–4) who underwent exclusive endoscopic drainage. Patients were grouped by stent type—uncovered self-expandable metal stents (UCSEMS), bilateral plastic stents, or a mixed approach (fully covered self-expandable metal stents + plastic)—as well as by drainage strategy (unilateral/bilateral) and use of radiofrequency ablation (RFA) or chemotherapy.
RESULTS
Patients receiving UCSEMS had significantly longer overall survival compared to those with plastic stents or the mixed approach (P < 0.0001). Mean stent occlusion times were 80 days (bilateral plastic), 84.4 days (mixed approach), and 122.5 days (UCSEMS; P < 0.0001). The mean number of ERCP reinterventions was highest in the UCSEMS group (5.4) compared to bilateral plastic (2.5) and mixed approach group (4.5; P < 0.0001). Patients who received RFA or chemotherapy had significantly longer survival (P < 0.0001).
CONCLUSION
Bilateral UCSEMS stenting appears most effective for palliative treatment of MHBO. Adjunctive use of RFA and chemotherapy may further enhance survival, supporting a personalized, multidisciplinary approach.
Core Tip: This retrospective cohort study analyzed 164 patients with malignant hilar biliary obstruction (MHBO) treated through endoscopic intervention using different stent types and drainage strategies. Uncovered self-expandable metal stents were associated with the longest survival and stent patency. Adjunctive therapies such as radiofrequency ablation and chemotherapy improved outcomes. The results support the patient-specific, multidisciplinary approach to MHBO management.
