DOI: 10.1097/mpa.0000000000002722 ISSN: 1536-4828

Multi-hole Versus Fully Covered Self-expandable Metal Stents for Distal Biliary Obstruction in Unresectable Pancreatic Cancer

Takashi Ito, Tsukasa Ikeura, Ayaka Orino, Koh Nakamaru, Masataka Masuda, Shinji Nakayama, Daisuke Hashimoto, Masashi Kanai, Sohei Satoi, Makoto Naganuma
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Objectives:

Self-expandable metallic stents (SEMS) are commonly used to treat biliary obstruction in patients with unresectable pancreatic cancer. Fully covered SEMS (FCSEMS) prevents tumor ingrowth but is prone to migration. Multi-hole SEMS (MHSEMS) has multiple holes in the stent membrane, prevents stent migration. This study compared time to recurrent biliary obstruction (TRBO) between MHSEMS and FCSEMS.

Methods:

We retrospectively enrolled patients with unresectable pancreatic cancer who underwent initial SEMS placement at our institution between January 2017 and December 2025. We evaluated TRBO, causes of obstruction, and stent-related adverse events (AEs). Risk factors for TRBO were assessed using univariate and multivariate analyses.

Results:

A total of 116 patients were included; and MHSEMS and FCSEMS were placed in 58 and 58 patients, each. Median TRBO was longer with MHSEMS than FCSEMS (394 vs. 238 d, P <0.01). The MHSEMS group had significantly fewer RBO, including migration, than the FCSEMS group ( P =0.01). Multivariate analysis identified MHSEMS use and chemotherapy after SEMS placement as being independently associated with reduced RBO. The rates of AEs, including post-endoscopic retrograde cholangiopancreatography-related pancreatitis, cholecystitis, and non-occlusive cholangitis, were similar between the groups.

Conclusions:

MHSEMS may be more effective than FCSEMS in patients with unresectable pancreatic cancer, offering reduced migration risk and better TRBO.

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