Multi-hole Versus Fully Covered Self-expandable Metal Stents for Distal Biliary Obstruction in Unresectable Pancreatic Cancer

OBJECTIVES: Self-expandable metallic stents (SEMS) are commonly used to treat biliary obstruction in patients with unresectable pancreatic cancer. Fully covered SEMS (FCSEMS) prevents tumor ingrowth but is prone to migration. Multi-hole SEMS (MHSEMS) has multiple holes in the stent membrane, prevents stent migration. This study compared time to recurrent biliary obstruction (TRBO) between MHSEMS and FCSEMS. METHODS: We retrospectively enrolled patients with unresectable pancreatic cancer who underwent initial SEMS placement at our institution between January 2017 and December 2025. We evaluated TRBO, causes of obstruction, and stent-related adverse events (AEs). Risk factors for TRBO were assessed using univariate and multivariate analyses. RESULTS: A total of 116 patients were included; and MHSEMS and FCSEMS were placed in 58 and 58 patients, each. Median TRBO was longer with MHSEMS than FCSEMS (394 vs. 238 d, P<0.01). The MHSEMS group had significantly fewer RBO, including migration, than the FCSEMS group (P=0.01). Multivariate analysis identified MHSEMS use and chemotherapy after SEMS placement as being independently associated with reduced RBO. The rates of AEs, including post-endoscopic retrograde cholangiopancreatography-related pancreatitis, cholecystitis, and non-occlusive cholangitis, were similar between the groups. CONCLUSIONS: MHSEMS may be more effective than FCSEMS in patients with unresectable pancreatic cancer, offering reduced migration risk and better TRBO.