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Indian J Gastroenterol. 2016 Sep;35(5):323-330. Epub 2016 Aug 27.

Covered versus uncovered self-expandable metal stents for malignant biliary strictures: A meta-analysis and systematic review.

Author information

1
Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA. harsha1778@yahoo.co.in.
2
Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, USA.
3
Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
4
Interventional Endoscopy Services, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
5
Department of Medicine, Division of Pulmonary Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.

Abstract

Self-expandable metal stents (SEMS) are used for palliating inoperable malignant biliary strictures. It is unclear if covered metal stents are superior to uncovered metal stents in these patients. We compared clinical outcomes in patients with covered and uncovered stents. Studies using covered and uncovered metallic stents for palliation in patients with malignant biliary stricture were reviewed. Articles were searched in MEDLINE, PubMed, and Ovid journals. Fixed and random effects models were used to calculate the pooled proportions. Initial search identified 1436 reference articles, of which 132 were selected and reviewed. Thirteen studies (n = 2239) for covered and uncovered metallic stents which met the inclusion criteria were included in this analysis. Odds ratio for stent occlusion rates in covered vs. uncovered stents was 0.79 (95 % CI = 0.65 to 0.96). Survival benefit in patients with covered vs. uncovered stents showed the odds ratio to be 1.29 (95 % CI = 0.95 to 1.74). Pooled odds ratio for migration of covered vs. uncovered stents was 9.9 (95 % CI = 4.5 to 22.3). Covered stents seemed to have significantly lesser occlusion rates, increased odds of migration, and increased odds of pancreatitis compared to uncovered stents. There was no statistically significant difference in the survival benefit, overall adverse event rate, and patency period of covered vs. uncovered metal stents in patients with malignant biliary strictures.

KEYWORDS:

Bile duct cancer; Obstructive jaundice; Palliation

PMID:
27566620
DOI:
10.1007/s12664-016-0682-8
[Indexed for MEDLINE]

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