Clinical Outcomes of Double Half‐Pigtail Versus Straight Plastic Stents for Endoscopic Biliary Drainage of Malignant Distal Biliary Obstruction

ABSTRACT Objectives The clinical performance of double half‐pigtail plastic stents (DHPs) for malignant distal biliary obstruction (MDBO) remains unclear. We compared DHPs with straight plastic stents (STs) regarding the timing, incidence, and causes of recurrent biliary obstruction (RBO). Methods This single‐center retrospective cohort study evaluated endoscopic retrograde cholangiopancreatography‐guided transpapillary single plastic stent placements for MDBO performed between October 2022 and March 2026. For the primary analysis, only initial stenting episodes were included. The primary endpoint was the time to RBO (TRBO), which was analyzed using Kaplan–Meier and log‐rank methods. Results A total of 131 stent‐placement episodes in 86 patients were eligible. The primary analysis included 72 patients undergoing initial stenting, comprising 20 patients in the DHP group and 52 patients in the ST group. The DHP and ST groups had a similar median TRBO (116 vs. 119 days; log‐rank p = 0.726), incidence of RBO (40.0% vs. 46.2%; p = 0.638), and incidence of stent occlusion (40.0% vs. 32.7%; p = 0.560). No migration occurred with DHPs, whereas seven migration events occurred with STs (0% vs. 13.5%; p = 0.084). Both groups had similar adverse event rates (0% vs. 11.5%; p = 0.113). Conclusions DHPs did not prolong the TRBO or reduce its incidence compared with STs. However, migration‐related RBO occurred only with STs. The potential advantage of DHPs may be a lower incidence of stent migration rather than longer overall stent patency. Trial Registration N/A