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 26 May 2018

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Plastic vs self-expandable metal stents for palliation in malignant biliary obstruction

February's publication of the American Journal of Gastroenterology compares plastic with self-expandable metal stents for palliation in malignant biliary obstruction.

News image

Self-expandable metal stents are thought to have an advantage over plastic stents in achieving biliary drainage.

Dr Alan Barkun and colleagues from Canada performed a systematic search of MEDLINE, EMBASE, Scopus, CENTRAL, and ISI Web of knowledge databases, from 1980 to 2015, for randomized-controlled trials comparing SEMS vs. plastic stents in the palliation of malignant biliary obstruction. 

The research team's primary outcomes were durations of stent patency, patient survival, and 30-day mortality. 

Numerous secondary outcomes were assessed, and extensive sensitivity and subgroup analyses were performed.

In all, the team identified 20 randomized-controlled trials totaling 1,713 patients that yielded a weighted mean difference in time to stent patency of almost 5 months favoring self-expandable metal stents. 

There was a longer patency of self-expandable metal stents for those without a prior drainage attempt
American Journal of Gastroenterology
The researchers observed no differences in overall patient survival, or 30-day mortality but there was a higher symptom-free survival at 6 months. 

Self-expandable metal stents use resulted in lower rates of late complications, sepsis or cholangitis, blocking from sludge, and mean number of re-interventions. 

The team found there was a longer patency of self-expandable metal stents for those without a prior drainage attempt. 

Although a survival advantage was found when an uncovered self-expandable metal stents was used, but not partially or fully covered self-expandable metal stents vs. plastic stents, and for self-expandable metal stents in the setting of pre- or post-procedural antibiotic administration, and performance of a sphincterotomy.

Dr Barkun's team concludes, "Keeping in mind the noted risk of bias in source data, the use of self-expandable metal stents compared with plastic stents, in the palliation of patients with malignant biliary obstruction results in longer stent patency, lower complications rates, and fewer re-interventions, whereas exhibiting survival benefits in selected subgroups of patients."

Am J Gastroenterol 2017; 112:260–273
15 February 2017

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