Singh V et al. (2007) Endoscopic intraluminal brachytherapy and metal stent in malignant hilar biliary obstruction: a pilot study. Liver Int 27: 347–352

Malignant hilar biliary obstruction is often unresectable at the time of diagnosis. Biliary drainage is a priority because it palliates the obstructive symptoms, but biliary drainage procedures have a high complication rate. Endoscopic placement of a metal stent is the preferred procedure, and unilateral stent placement can provide sufficient drainage for symptom palliation in these patients. Intraluminal brachytherapy (ILBT)—which delivers high-dose radiation to a bile-duct tumor whilst minimizing exposure of nearby organs—prolongs stent patency by slowing tumor ingrowth, so combining the use of both unilateral metal stenting and ILBT could provide an effective option for palliation of malignant hilar biliary obstruction.

In this pilot study Singh et al. evaluated stent patency and survival in eight patients with type II malignant hilar biliary obstruction who underwent endoscopic, contrast-free placement of a metal stent, followed 4 weeks later by endoscopic ILBT. These patients were compared with a historical control group of 10 patients who underwent contrast-free stent placement alone. Stent patency duration was longer in the ILBT-treated group than the control group: (mean ± SD) 305 ± 183.96 days versus 143.9 ± 115.11 days, respectively, P = 0.03. Survival (mean ± SD) was also prolonged in the ILBT-treated group compared with the control group: 310 ± 192.68 days versus 154.9 ± 122.51 days, respectively, P = 0.05. Estimated median survival by Kaplan–Meier analysis was 225 days for ILBT-treated patients and 100 days for controls (P = 0.025). None of the patients developed major complications related to stent or ILBT treatment.

The authors call for a large, randomized, controlled trial to confirm the favorable findings of their pilot study.