Results of endoscopic treatment of recurrent malignant biliary obstruction in patients with self-expanding metal stents

Background and Aim: Endoscopic biliary drainage with placement of a self-expanding metal stent (SEMS) is the preferred palliative treatment of malignant biliary obstruction. Recent advances in the treatment have prolonged survival, thus increasing the chance of recurrent biliary obstruction (RBO) after SEMS placement. The aim of this study was to compare different endoscopic approaches in patients with a SEMS and RBO, regarding clinical success and time to RBO. Methods This retrospective study included all patients with a SEMS placed because of malignant biliary strictures who underwent endoscopic retrograde cholangiopancreatography between January 2011 and December 2018. We evaluated the results of different endoscopic interventions to RBO, including insertion of a new SEMS, stent cleaning, and insertion of a plastic stent (PS). Results From January 2011 to December 2018, 70 (22.4%) patients developed RBO requiring endoscopic reintervention ( n  = 105 sessions). From the 105 ERCPs, technical success, clinical success and adverse events rates were 91,4%, 71,8%, 7,8%, respectively. Younger age (OR = 1.11 95%CI: 1.03–1.19) and the finding of a patent SEMS (OR = 0.17 95%CI: 0.04–0.08) were predictors of clinical failure ( P  = 0.006 and P  = 0.024, respectively). The mean patency time (in days) after endoscopic reintervention was greater for SEMSs than for PSs (417.2 [95% CI: 250.0–584.4] vs 175.2 [95% CI: 124.0–226.5], P  = 0.002). Conclusions Correct identification and treatment of the causal factor of RBO typically leads to technical and clinical success. Placement of a second SEMS provides longer patency compared to a plastic stent if ingrowth (overgrowth) occurs.