Clinical utility of suprapapillary plastic stents for lifelong biliary drainage in unresectable malignant hilar biliary obstruction

Lifelong maintenance of biliary drainage in unresectable malignant hilar biliary obstruction (MHBO) is becoming increasingly critical, as advancements in antitumor therapy improve patient prognosis. We aimed to evaluate lifelong biliary drainage (LBD) outcomes using suprapapillary plastic stent (SPPS) versus self-expandable metallic stent (SEMS) as the initial stent for unresectable MHBO. This retrospective single-center study included 106 consecutive patients who underwent biliary drainage for unresectable MHBO with SPPS or SEMS placement above the papilla via endoscopic retrograde cholangiopancreatography between April 2014 and March 2023. The primary outcome was the time to LBD failure (TLBDF). The secondary outcome was time to recurrent biliary obstruction (TRBO), overall survival (OS), the success rate of LBD at 250 and 500 days, and the LBD-related medical costs. The TLBDF in the SPPS group was significantly longer than that in the SEMS group (p=0.037), while the TRBO was longer in the SEMS group than the SPPS group (211 days vs. 149 days, p=0.027). The success rate of LBD at 250 and 500 days in the SPPS group (95.0%, 95.0%) was higher than that in the SEMS group (80.1%, 54.2%). No significant difference was observed in OS and the LBD-related medical costs between the groups. SPPS, as the first stent for unresectable MHBO, was considered superior to SEMS for the intermittent maintenance of LBD. Achieving LBD success or extending TLBDF may help preserve therapeutic options.