Optimal stent placement strategy for malignant hilar biliary obstruction: a management dilemma

We read the article by Xia et al1Xia M.X. Cai X.B. Pan Y.L. al.Optimal stent placement strategy for malignant hilar biliary obstruction: a large multicenter parallel study.Gastrointest Endosc. 2020; 91: 1117-1128Abstract Full Text PDF PubMed Scopus (18) Google Scholar with great interest. The addresses dilemma of endoscopic management obstruction (MHBO) because no universal consensus is available. authors compared 4 major modalities to determine optimal and concluded that dual metal preferred palliation inoperable MHBO if technically feasible. study rightly excluded patients unresectable these are best treated conservatively owing limited prognosis. intervention preferable where decompression mandated, but obviously it not without risks.2Dumonceau J.M. Tringali A. Papanikolaou I.S. al.Endoscopic stenting: indications, choice stents, results: European Society Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017.Endoscopy. 2018; 50: 910-930Crossref (184) It would be useful compare results in percutaneous transhepatic drainage. like ask why rates stents traversing papilla were different between bilateral unilateral matched cohorts (23.7% vs 90%-100%) other groups. Could this reflect differences technique, which affected outcomes? 7F easier deploy inferior 10F terms patency drainage.3Zorrón Pu L. de Moura E.G. Bernardo W.M. stenting systematic review meta-analysis.World J Gastroenterol. 2015; 21: 13374-13385Crossref (44) A subgroup analysis plastic could shed light on important aspect. This has potential change clinical practice we classify interventions Bismuth subgroups. Patients type IV stage cholangiocarcinoma expected have shorter life spans, reasonable palliate them as was observed study.1Xia Scholar,4Sripongpun P. Attasaranya S. Chamroonkul N. al.Simple score predict 24-week survival times distal tool selecting palliative metallic or stents.J Gastrointest Cancer. 49: 138-143Crossref (3) However, noted only 17% had II/III disease. Such live longer than year current available therapeutic options.5Mavros M.N. Economopoulos K.P. Alexiou V.G. al.Treatment prognosis intrahepatic cholangiocarcinoma: meta-analysis.JAMA Surg. 2014; 149: 565-574Crossref (344) If analyzed separately from IV, been different? Infectious adverse events an “Achilles heel” strictures. Over time, associated cholangitis resulting tissue ingrowth. Can justify placing unremovable expectancy much year? All disclosed financial relationships. Optimal studyGastrointestinal EndoscopyVol. 91Issue 5PreviewThe remains extremely challenging consensus. For first aiming strategy. Full-Text ResponseGastrointestinal 93Issue 2PreviewWe thank Dr Hasan colleagues1 their interest our recent report comparison approaches (MHBO). retrospective revealed that, possible, self-expandable (SEMS) should palliation, followed single stent, patient population.2