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Drug Therapy / Biliary Tract Neoplasms / Cholangiocarcinoma · Journal article
Den Open · May 23, 2026
Encouraging direction, but not yet definitive.
In 81 patients with malignant hilar biliary obstruction treated with stenting and chemotherapy, time to first reintervention (TTFR) correlated with overall survival and stenting above the sphincter of Oddi was the only independent factor prolonging TTFR on multivariable analysis. The survival benefit of above-SO stenting emerged after 2 months, suggesting this approach may be preferable for patients expected to continue chemotherapy beyond that timeframe.
Retrospective cohort study. 81 patients with malignant hilar biliary obstruction who underwent biliary stenting followed by chemotherapy. Intervention: Stenting above the sphincter of Oddi. Compared with: Stenting across the sphincter of Oddi. n = 81.
TTFR correlated with overall survival (r = 0.60, p < 0.01) Stenting above the sphincter of Oddi was the only independent factor associated with longer TTFR (HR 0.44, p = 0.01) TTFR at 6 months was 69%-73% in the above-SO group versus 27%-42% in the across-SO group
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
For patients with malignant hilar obstruction expected to receive chemotherapy beyond 2 months and without prior endoscopic sphincterotomy, stenting above the sphincter of Oddi may extend time to reintervention and correlate with improved survival. This retrospective finding warrants validation in prospective studies before altering standard drainage protocols.
Retrospective cohort shows stenting strategy impacts time to reintervention and survival in chemotherapy-treated malignant hilar obstruction, with one independent factor identified in multivariable analysis.
As stated by the source record.
Quoted from the source exactly as published.
For patients with malignant hilar obstruction expected to receive chemotherapy beyond 2 months and without prior endoscopic sphincterotomy, stenting above the sphincter of Oddi may extend time to reintervention and correlate with improved survival. This retrospective finding warrants validation in prospective studies before altering standard drainage protocols.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Objectives. Advances in chemotherapy have increased survival in biliary tract cancer patients, and reports of the effectiveness of neoadjuvant therapy are emerging. Accordingly, developing optimal drainage strategies under chemotherapy is important. We aimed to clarify suitable drainage methods and assess the prognostic value of the time to first reintervention (TTFR) following chemotherapy induction.Methods. We retrospectively analyzed 81 patients with malignant hilar biliary obstruction (MHBO) who underwent biliary stenting followed by chemotherapy between April 2012 and October 2023. TTFR following chemotherapy induction and drainage- and survival-related factors were evaluated.Results. The median follow-up, survival, and TTFR were 425, 479, and 167 days, respectively. TTFR was correlated with overall survival (r = 0.60, p < 0.01). Univariable analyses identified prechemotherapy cholangitis and stenting above the sphincter of Oddi (SO) as factors associated with shorter TTFR, whereas multivariable analysis revealed stenting above the SO as the only independent factor (hazard ratio [HR] 0.44, p = 0.01). Among 52 non-endoscopic sphincterotomy (EST) patients, prechemotherapy cholangitis (HR 2.05, p = 0.04), stenting above the SO (HR 0.47, p = 0.04), and multiple drainage segments (HR 0.42, p = 0.04) influenced TTFR in univariable analyses. No significant factor was detected among 28 patients undergoing EST. The TTFR was comparable between above- and across-SO placement groups up to 2 months, but superior in the above-SO group at 6 months (69%-73% vs. 27%-42%).Conclusions. TTFR following chemotherapy induction is a prognostic factor in MHBO patients. Stenting above the SO may prolong TTFR, particularly in those without prior EST or expected to continue chemotherapy beyond 2 months. Trial Registration: N/A.
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