Supra-papillary Versus Trans-papillary Biliary Stenting in Malignant Peri-hilar Stenosis

NCT07325877 | Not Yet Recruiting DMC

• 1 other identifier: ID0001
• Study Type: interventional
• Target: 70
• Locations: 0 countries
• Sites: N/A

Brief Summary

This is a randomized controlled trial comparing patients with obstructive jaundice due to malignancies of the perihilar area of bile ducts and undergoing both preoperative and palliative biliary drainage. The comparison will focus on the technique:, on the one hand, an arm of patients undergoing standard-of-care ERCP with trans-papillary plastic protesis placement, and on the other hand, an experimental arm of patients undergoing suprapapillary plastic protesis placement with no sphincterotomy. The primary objective will be to compare the time-to-stent dysfunction in the two groups; secondary objectives will include a comparison of the safety, technical, and clinical success of the procedures.

Conditions

Biliary Disease Tract; Biliary Stenosis; Biliary Stents

Keywords

ERCP; Malignant Biliary Stenosis; Supra-papillary; Trans-Papillary

Outcome Measures

Primary Outcomes (1)

• Time-to-Stent disfunction

  In days, calculated from the index procedure. Stent(s) dysfunction, which includes occlusion or migration of the stent(s) and tumour ingrowth/overgrowth, is defined as the presence of at least two of the following three criteria: 1. New dilation of the biliary tree on imaging: 2. Bilirubin level above 2 mg/dL (34.2 mmol/L) with a new increase ≥ 1 mg/dL compared with the value after initial clinical success, or elevation of alkaline phosphatase and/or g-glutamyl transferase greater than 2 times the upper normal limit with a new elevation of 30 U/L 3. Cholangitis, characterized by fever along with leucocytosis (\> 10,000/mL) or C-reactive protein levels above 20 mg/dL.

  From index procedure to a minimum of one year of follow up.

Secondary Outcomes (3)

• Safety of the procedure

  From the index procedure within 14 days.

• Technical success

  At the moment of index procedure.

• Clinical Success

  Between 14 and 30 days from the index procedure.

Study Arms (2)

Suprapapillary

EXPERIMENTAL

ERCP for malignant stenosis of bile duct with suprapapillary stents positioning (experimental)

Procedure: ERCP with suprapapillary stent placement

Trans Papillary

ACTIVE COMPARATOR

ERCP for malignant stenosis of bile duct with transpapillary stents positioning (Standard of care).

Procedure: ERCP with transpapillary stent placement

Interventions

ERCP with suprapapillary stent placement PROCEDURE

ERCP with no sphincterotomy and placement of plastic stents above the papilla of Vater.

Suprapapillary

ERCP with transpapillary stent placement PROCEDURE

Standard ERCP with or without sphincterotomy with trans papillary stent placement

Trans Papillary

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Radiological/ biochemical/pathological diagnosis of malignant OJ.
• Stenosis maximum extent may be 2 cm after biliary confluence.
• Documented obstructive jaundice (serum bilirubin \> 3 mg/dL).
• Indication for biliary drainage (preoperative or palliative).
• Age ≥ 18 years.
• Signed informed consent.

You may not qualify if:

• Contraindications to endoscopic approach (duodenal stenosis, surgically altered anatomy).
• Previous sphincterotomy or drainage.
• Involvement of the papilla of Vater by the tumour.
• Uncontrolled coagulopathy (INR \> 1.5 uncorrectable or \<50.000 PLTs).
• Ongoing uncontrolled cholangitis as defined according to the Tokyo 2018 Guidelines, or systemic sepsis.

Sponsors & Collaborators

• Azienda Ospedaliera Universitaria Integrata Verona: lead

Related Publications (16)

• Naitoh I, Inoue T. Optimal endoscopic drainage strategy for unresectable malignant hilar biliary obstruction. Clin Endosc. 2023 Mar;56(2):135-142. doi: 10.5946/ce.2022.150. Epub 2023 Jan 5.

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• Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN; REDCap Consortium. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019 Jul;95:103208. doi: 10.1016/j.jbi.2019.103208. Epub 2019 May 9.

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• Kiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gabata T, Hata J, Liau KH, Miura F, Horiguchi A, Liu KH, Su CH, Wada K, Jagannath P, Itoi T, Gouma DJ, Mori Y, Mukai S, Gimenez ME, Huang WS, Kim MH, Okamoto K, Belli G, Dervenis C, Chan ACW, Lau WY, Endo I, Gomi H, Yoshida M, Mayumi T, Baron TH, de Santibanes E, Teoh AYB, Hwang TL, Ker CG, Chen MF, Han HS, Yoon YS, Choi IS, Yoon DS, Higuchi R, Kitano S, Inomata M, Deziel DJ, Jonas E, Hirata K, Sumiyama Y, Inui K, Yamamoto M. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):17-30. doi: 10.1002/jhbp.512. Epub 2018 Jan 5.

  PMID: 29032610 BACKGROUND

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  PMID: 34890695 BACKGROUND

• Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, Mergener K, Nemcek A Jr, Petersen BT, Petrini JL, Pike IM, Rabeneck L, Romagnuolo J, Vargo JJ. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010 Mar;71(3):446-54. doi: 10.1016/j.gie.2009.10.027. No abstract available.

  PMID: 20189503 BACKGROUND

• Kovacs N, Pecsi D, Sipos Z, Farkas N, Foldi M, Hegyi P, Bajor J, Eross B, Marta K, Miko A, Rakonczay Z Jr, Sarlos P, Abraham S, Vincze A. Suprapapillary Biliary Stents Have Longer Patency Times than Transpapillary Stents-A Systematic Review and Meta-Analysis. J Clin Med. 2023 Jan 23;12(3):898. doi: 10.3390/jcm12030898.

  PMID: 36769545 BACKGROUND

• Okamoto T, Fujioka S, Yanagisawa S, Yanaga K, Kakutani H, Tajiri H, Urashima M. Placement of a metallic stent across the main duodenal papilla may predispose to cholangitis. Gastrointest Endosc. 2006 May;63(6):792-6. doi: 10.1016/j.gie.2005.05.015.

  PMID: 16650540 BACKGROUND

• Keulen AV, Gaspersz MP, van Vugt JLA, Roos E, Olthof PB, Coelen RJS, Bruno MJ, van Driel LMJW, Voermans RP, van Eijck CHJ, van Hooft JE, van Lienden KP, de Jonge J, Polak WG, Poley JW, Pek CJ, Moelker A, Willemssen FEJA, van Gulik TM, Erdmann JI, Hol L, IJzermans JNM, Buttner S, Koerkamp BG. Success, complication, and mortality rates of initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma. Surgery. 2022 Dec;172(6):1606-1613. doi: 10.1016/j.surg.2022.06.028. Epub 2022 Aug 18.

  PMID: 35989132 BACKGROUND

• Ipek S, Alper E, Cekic C, Cerrah S, Arabul M, Aslan F, Unsal B. Evaluation of the effectiveness of endoscopic retrograde cholangiopancreatography in patients with perihilar cholangiocarcinoma and its effect on development of cholangitis. Gastroenterol Res Pract. 2014;2014:508286. doi: 10.1155/2014/508286. Epub 2014 May 27.

  PMID: 24982670 BACKGROUND

• Vogel A, Bridgewater J, Edeline J, Kelley RK, Klumpen HJ, Malka D, Primrose JN, Rimassa L, Stenzinger A, Valle JW, Ducreux M; ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Biliary tract cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2023 Feb;34(2):127-140. doi: 10.1016/j.annonc.2022.10.506. Epub 2022 Nov 10. No abstract available.

  PMID: 36372281 BACKGROUND

• Qumseya BJ, Jamil LH, Elmunzer BJ, Riaz A, Ceppa EP, Thosani NC, Buxbaum JL, Storm AC, Sawhney MS, Pawa S, Naveed M, Lee JK, Law JK, Kwon RS, Jue TL, Fujii-Lau LL, Fishman DS, Calderwood AH, Amateau SK, Al-Haddad M, Wani S. ASGE guideline on the role of endoscopy in the management of malignant hilar obstruction. Gastrointest Endosc. 2021 Aug;94(2):222-234.e22. doi: 10.1016/j.gie.2020.12.035. Epub 2021 May 20.

  PMID: 34023067 BACKGROUND

• Boulay BR, Birg A. Malignant biliary obstruction: From palliation to treatment. World J Gastrointest Oncol. 2016 Jun 15;8(6):498-508. doi: 10.4251/wjgo.v8.i6.498.

  PMID: 27326319 BACKGROUND

• Hameed A, Pang T, Chiou J, Pleass H, Lam V, Hollands M, Johnston E, Richardson A, Yuen L. Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma - a systematic review and meta-analysis. HPB (Oxford). 2016 May;18(5):400-10. doi: 10.1016/j.hpb.2016.03.002. Epub 2016 Apr 4.

  PMID: 27154803 BACKGROUND

• Pavlidis ET, Pavlidis TE. Pathophysiological consequences of obstructive jaundice and perioperative management. Hepatobiliary Pancreat Dis Int. 2018 Feb;17(1):17-21. doi: 10.1016/j.hbpd.2018.01.008. Epub 2018 Jan 31.

  PMID: 29428098 BACKGROUND

• Ruzzenente A, Alaimo L, Caputo M, Conci S, Campagnaro T, De Bellis M, Bagante F, Pedrazzani C, Guglielmi A. Infectious complications after surgery for perihilar cholangiocarcinoma: A single Western center experience. Surgery. 2022 Sep;172(3):813-820. doi: 10.1016/j.surg.2022.04.028. Epub 2022 May 24.

  PMID: 35618490 BACKGROUND

• Valle JW, Kelley RK, Nervi B, Oh DY, Zhu AX. Biliary tract cancer. Lancet. 2021 Jan 30;397(10272):428-444. doi: 10.1016/S0140-6736(21)00153-7.

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MeSH Terms

Conditions

Biliary Tract Diseases

Interventions

Cholangiopancreatography, Endoscopic Retrograde

Condition Hierarchy (Ancestors)

Digestive System Diseases

Intervention Hierarchy (Ancestors)

Cholangiography; Radiography, Abdominal; Radiography; Diagnostic Imaging; Diagnostic Techniques and Procedures; Diagnosis; Diagnostic Techniques, Digestive System; Endoscopy, Digestive System; Endoscopy; Diagnostic Techniques, Surgical; Digestive System Surgical Procedures; Surgical Procedures, Operative; Minimally Invasive Surgical Procedures

Study Officials

• Andrea Ruzzenente, Professor

  Integrated University Hospital Verona

  PRINCIPAL INVESTIGATOR

• Stefano Francesco Crinò, Consultant

  Integrated University Hospital Verona

  STUDY DIRECTOR

• Edoardo Poletto, PhD Candidate, Consultant

  Integrated university Hospital Verona

  STUDY CHAIR

• Maria Cristina Conti Bellocchi, Consultant

  Integrated University Hospital Verona

  STUDY CHAIR

Central Study Contacts

Andrea Ruzzenente, Professor

CONTACT

+39 0458124644; andrea.ruzzenente@univr.it

Edoardo Poletto, PhD Candidate - Consultant

CONTACT

+39 3452308635; edoardo.poletto@univr.it

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Model Details: This is a single-blinded randomized controlled trial comparing two techniques used for the same procedure (ERCP and biliary stenting, suprapapillary vs transpapillary placement).

Study Record Dates

• First Submitted: December 16, 2025
• First Posted: January 8, 2026
• Study Start: March 1, 2026
• Primary Completion (Estimated): March 1, 2029
• Study Completion (Estimated): March 1, 2029
• Last Updated: January 8, 2026

Record last verified: 2026-01