Biliary self-expandable metallic stent combined with Iodine-125 seeds strand in the treatment of hilar malignant biliary obstruction

OBJECTIVE: To assess the safety and effectiveness of a self-expandable metallic stent (SEMS) combined with Iodine-125 seeds strand to treat hilar malignant biliary obstruction (MBO). METHODS: This retrospective study included patients who had received SEMS with (125)I seeds strand (seeds group) or SEMS alone (controls) to treat hilar MBO. Demographic, biochemical, stent patency, overall survival and complications data were extracted and analysed. RESULTS: A total of 76 patients were included (seeds group, n = 40; controls, n = 36), with a total of 608 seeds deployed in the seeds group (mean, 15.2 ± 4.1 [range, 8–25] seeds per patient). Statistically significant between-group differences were shown in median stent patency time (seeds group, 387.0 ± 27.9 days [95% confidence interval {CI} 332.4, 441.6] versus controls, 121.0 ± 9.1 days [95% CI 103.2, 138.8]) and in median overall survival (seeds group, 177.0 ± 17.9 days [95% CI 141.8, 212.2] versus controls, 123.0 ± 20.4 [95% CI 83.0, 163.0]). There were no statistically significant between-group differences in complication rates. CONCLUSION: SEMS combined with (125)I seeds strand is safe, feasible, and tolerable in treating patients with hilar MBO, and may be effective in prolonging stent patency time and overall survival.