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Biliary Disease TractSupraBilSNCT07325877

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

A study testing ERCP with suprapapillary stent placement and ERCP with transpapillary stent placement in people with Biliary Disease Tract and Biliary Stenosis, run by Azienda Ospedaliera Universitaria Integrata Verona.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial 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. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
ERCP with suprapapillary stent placement and ERCP with transpapillary stent placement
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
70 participants
Where
No sites listed yet
Study dates
1 Mar 2026to 1 Mar 2029
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 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.

Who cannot join

  • 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.

Trial locations and contacts

No sites are listed yet. Contact the study team or a site near you to ask about taking part.

Andrea Ruzzenente, Professor contact

+39 0458124644

andrea.ruzzenente@univr.it

Edoardo Poletto, PhD Candidate - Consultant contact

+39 3452308635

edoardo.poletto@univr.it

About this study

Official title: Supra-papillary Versus Trans-papillary Biliary Stenting in Malignant Peri-hilar Stenosis (SupraBilS): a Randomized Controlled Trial

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.

Being tested
ERCP with suprapapillary stent placement, ERCP with transpapillary stent placement
Keywords
ERCP, Malignant Biliary Stenosis, Supra-papillary, Trans-Papillary
Medical subject headings
Biliary Tract Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ERCP with suprapapillary stent placementProcedure or surgery

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

  • ERCP with transpapillary stent placementProcedure or surgery

    Standard ERCP with or without sphincterotomy with trans papillary stent placement

Study groups in NCT07325877
Study groupRoleWhat they receive
SuprapapillaryExperimentalERCP for malignant stenosis of bile duct with suprapapillary stents positioning (experimental)
Receives: Procedure: ERCP with suprapapillary stent placement
Trans PapillaryActive comparatorERCP for malignant stenosis of bile duct with transpapillary stents positioning (Standard of care).
Receives: Procedure: ERCP with transpapillary stent placement

What is being measured

The primary outcome is the main question the study is designed to answer.

  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.

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

Secondary outcomes (3)
  1. Safety of the procedure

    The incidence of Adverse events and severe adverse events will be compared. Adverse events (AEs) (timepoint 14 days) are defined according to the ASGE lexicon and graded according to the Adverse Events in GI endoscopy (AGREE) classification that classifies AEs in 5 grades from Grade I, any deviation from standard postprocedural course without need for pharmacological or interventional treatment, to Grade V, death of the patient. Sub-group analysis will be performed for procedure-related AEs. Severe adverse events are defined as AGREE≥3.

    Measured: From the index procedure within 14 days.

  2. Technical success

    Defined as the placement of the stent(s) in the desired position (timepoint 0)

    Measured: At the moment of index procedure.

  3. Clinical Success

    Defined as the reduction of bilirubin level ≥50% or at a level <2 mg/dL (34.2 mmol/L).

    Measured: Between 14 and 30 days from the index procedure.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Jan 2026
  2. Study start1 Mar 2026 (estimated)
  3. Primary completion1 Mar 2029 (estimated)
  4. Study completion1 Mar 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
This is a single-blinded randomized controlled trial comparing two techniques used for the same procedure (ERCP and biliary stenting, suprapapillary vs transpapillary placement).
Masking
Single blind
Who is masked
Participant
Enrolment
70 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07325877
Sponsor's protocol ID
ID0001
Other IDs
ID0001
Acronym
SupraBilS
Status last verified
Jan 2026
First submitted
16 Dec 2025
Last updated
8 Jan 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: Question asked to the ethics committee, decision is still pending.

Publications

  • 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.

    PubMed 36600654
  • 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.

    PubMed 31078660
  • 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.

    PubMed 29032610
  • Nass KJ, Zwager LW, van der Vlugt M, Dekker E, Bossuyt PMM, Ravindran S, Thomas-Gibson S, Fockens P. Novel classification for adverse events in GI endoscopy: the AGREE classification. Gastrointest Endosc. 2022 Jun;95(6):1078-1085.e8. doi: 10.1016/j.gie.2021.11.038. Epub 2021 Dec 8.

    PubMed 34890695
  • 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.

    PubMed 20189503
  • 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.

    PubMed 36769545
  • 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.

    PubMed 16650540
  • 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.

    PubMed 35989132
  • 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.

    PubMed 24982670
  • 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.

    PubMed 36372281
  • 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.

    PubMed 34023067
  • 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.

    PubMed 27326319
  • 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.

    PubMed 27154803
  • 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.

    PubMed 29428098
  • 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.

    PubMed 35618490

Questions about this trial

What is this clinical trial studying?

A study testing ERCP with suprapapillary stent placement and ERCP with transpapillary stent placement in people with Biliary Disease Tract and Biliary Stenosis, run by Azienda Ospedaliera Universitaria Integrata Verona.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 8 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Andrea Ruzzenente, Professor (+39 0458124644, andrea.ruzzenente@univr.it), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Time-to-Stent disfunction (time frame: From index procedure to a minimum of one year of follow up.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07325877, which also lists 16 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Jan 2026.

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