Multi-hole self-expandable metallic stents versus partially covered self-expandable metallic stents for malignant distal biliary obstruction: A comparative study

Background: The novel multi-hole self-expandable metallic stent (MH-SEMS) have been reported the long patency with lower risk of stent migration. However, no studies have directly compared MH-SEMS with conventional partially covered self-expandable metallic stent (PC-SEMS).
Methods: We compared the stent patency between patients with MH-SEMS (MH group: n = 83) and those with PC-SEMS (PC group: n = 126) for malignant distal biliary obstruction (MDBO) from December 2017 to August 2024.
Results: Pancreatic cancer was the leading cause of MDBO. Clinical success rates (97.6% vs. 99.2%), overall survival, adverse event incidence rates, including cholecystitis, recurrent biliary obstruction (RBO) incidence rates (32.1% vs. 24.0%), and migration rates (4.9% vs. 4.0%) did not significantly differ between the two groups. However, the median time to RBO was more likely to be shorter (299 vs. 462 days, p = 0.053) and tumor ingrowth was significantly more prevalent in the MH group (8.6% vs. 0.8%, p < 0.01). Stent removal was successful in all patients in the MH group (11 patients) and in 4 of 6 patients in the PC group (100% vs. 66.7%, p = 0.098).
Conclusions: MH-SEMS and PC-SEMS demonstrated comparable outcomes, but MH-SEMS has the advantage of having less risk of migration and is easily removable. However, due to increased tumor ingrowth, the stent patency of MH-SEMS may be shorter than that of PC-SEMS.