The systematic use of metal stents to treat biliary obstruction is restricted by high cost, compared with plastic stents.
In this study, researchers from France compared the cost and efficacy of plastic and metal stents in the treatment of patients with malignant common bile duct strictures.
They also identified factors that predicted the survival of these patients.
The team randomized 118 patients (mean age 75 years), with malignant strictures of the common bile duct, to receive either a plastic or metal stent.
The researchers compared the 2 treatments using Mann-Whitney and chi-square tests.
In addition, survival rates were compared with a Cox proportional hazards model.
The team found no significant difference in survival between the 2 groups.
|Time to first obstruction was longer for patients in the metal stent group.|
They determined that time to first obstruction was longer for patients in the metal stent group.
Furthermore, additional days of hospitalization, days of antibiotic therapy, and number of ERCPs and transabdominal US procedures were significantly higher in the plastic stent group.
Using multivariate analysis the team determined that the presence of liver metastases was the only factor independently related to survival. This variable defined a group with a shorter survival.
The median survival of patients with hepatic metastasis at diagnosis was 2.7 months, compared with 5.3 months for patients without liver metastasis. The team determined that in the latter group, the overall cost associated with metal stents was lower than for plastic.
Dr Mehdi Kaassis’s team concluded, “Metal stent placement is the most effective treatment of inoperable malignant common bile duct stricture”.
“Placement of a metal stent is cost effective in patients without hepatic metastases, whereas a plastic stent should be placed in patients with spread of the tumor to the liver.”