Clinical Outcomes of Plastic versus Self-Expanding Metal Stents in Malignant Hilar Biliary Obstruction

This retrospective study compared plastic stents (PS) and self-expanding metal stents (SEMS) in 86 patients with unresectable malignant hilar biliary obstruction (MHBO) treated between 2015 and 2022. In univariate analysis, SEMS were associated with higher clinical success (76.9% vs. 51.1%) and significantly longer stent patency (median 213 vs. 78 days) compared to PS. They also showed a lower risk of recurrent biliary obstruction. However, overall survival did not differ significantly between groups. Multivariate analysis revealed that better ECOG performance status and lower bilirubin levels, rather than stent type, predicted improved clinical outcomes. SEMS offer superior durability, but stent selection should be guided by individual patient characteristics.