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Side-by-side metal stenting showed strong clinical success and low complication rates in managing unresectable malignant hilar biliary obstruction.

A study published in June 2025 issue of BMC Gastroenterology underscored the clinical uncertainty surrounding simultaneous side-by-side deployment of uncovered self-expanding metal stents (SEMS) as a palliative strategy for malignant hilar biliary obstruction (MHBO).  

Researchers conducted a retrospective study to assess the feasibility, efficacy, and safety of simultaneous side-by-side placement of SEMS in MHBO.  

They reviewed records of all individuals treated for MHBO between May 2019 and February 2023. The analysis included technical and clinical success rates as primary endpoints. Secondary endpoints involved complication rates, recurrent biliary obstruction, time to recurrence, need for reintervention, and overall mortality.  

The results showed that 15 individuals (mean age, 63 years; 8 men) underwent simultaneous side-by-side metal stent placement for MHBO. Obstruction was classified as Bismuth type III (n = 1) or IV (n = 14). Technical and clinical success rates reached 100% and 3 underwent the combined percutaneous endoscopic rendezvous technique with uncovered SEMS. The complication rate was 13.3%, with 2 developing recurrent biliary obstruction and cholangitis. The median time to recurrence was 97.5 days (range: 93–102 days), and both required reintervention. The 30-day mortality rate was 6.7% (n = 1).  

Investigators concluded that simultaneous side-by-side deployment of uncovered SEMS was a feasible and safe approach for unresectable MHBO, with high success rates and potential utility in complex anatomy when combined with the percutaneous endoscopic rendezvous technique. 

Source: bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-04053-0