The efficacy and safety of balloon dilation for unresectable malignant biliary obstruction before placement of self-expanding metal stents.

AIM: We aimed to evaluate whether patients with malignant biliary obstruction (MBO) could benefit from balloon dilation before the placement of self-expanding metal stent (SEMS) for palliative biliary drainage. METHODS: Consecutive patients who underwent ERCP with SEMS placement for palliative management of MBO were retrospectively included. Comparative analyses were performed on decreased serum bilirubin levels, post-procedural adverse events, patency duration, stent dysfunction and survival time between the groups. RESULTS: A total of 221 patients underwent palliative endoscopic SEMS implantation for MBO were included from January 2014 to June 2018. Dilation increased the percentage of decreased serum bilirubin (37.0% vs 14.3%, P = 0.001) and there was a decreaseing trend of the incidence of post-procedural cholangitis (2.5% vs 7.8%, P = 0.075), while the rates of other adverse events such as pancreatitis and bleeding were not increased. The patency duration of the SEMS and survival time were not significantly different in patients with or without dilation. However, temporary endoscopic nasobiliary drainage (ENBD) after SEMS insertion could also achieve short-term efficacy. Patients with ENBD but without dilation showed similar short-term outcome as compared to patients with dilation but without ENBD. CONCLUSIONS: Dilation with small caliber balloon catheter before SEMS insertion is a safe and effective approach for MBO. Balloon dilation could improve the short-term efficacy of SEMES, while the long-term outcomes were not obviously affected. The short-term effect of stricture dilation could be replaced by ENBD. However, further studies are essential to confirm the current results. This article is protected by copyright. All rights reserved.