Comparison of the utility of covered metal stents versus uncovered metal stents in the management of malignant biliary strictures in 749 patients

• Published in: Gastrointestinal endoscopy 2013-08, Vol.78 (2), p.312-324
• Main Authors: Lee, Jeffrey H., MD, MPH, Krishna, Somashekar G., MD, Singh, Amanpal, MD, MS, Ladha, Harshad S., MBBS, Slack, Rebecca S., MS, Ramireddy, Srinivas, MD, Raju, Gottumukkala S., MD, Davila, Marta, MD, Ross, William A., MD
• Format: Article
• Language: English
• Subjects: Aged; Cholangiopancreatography, Endoscopic Retrograde - instrumentation; Cholestasis - etiology; Cholestasis - therapy; Cohort Studies; Disease-Free Survival; Equipment Design; Equipment Failure; Female; Gastroenterology and Hepatology; Humans; Male; Metals; Middle Aged; Pancreatic Neoplasms - complications; Recurrence; Retrospective Studies; Stents; Treatment Outcome
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2013.02.032

Background Self-expandable metal stents (SEMSs) are used to relieve malignant biliary obstruction. Objective To compare outcomes between covered self-expandable metal stents (CSEMSs) and uncovered self-expandable metal stents (USEMSs) in malignant biliary obstruction. Design Retrospective cohort study. Setting Tertiary cancer center. Patients Patients with malignant biliary obstruction. Interventions Placement of CSEMS or USEMS. Main outcome measurements Time to recurrent biliary obstruction (TRO), overall survival (OS), and adverse events. Results From January 2000 to June 2011, 749 patients received SEMSs: 171 CSEMSs and 578 USEMSs. At 1 year, there was no significant difference in the percentage of patients with recurrent obstruction (CSEMSs, 35% vs USEMSs, 38%) and survival (CSEMSs, 45% vs USEMSs, 49%). There was no significant difference in the median OS (CSEMSs, 10.4 months vs USEMSs, 11.8 months; P  = .84) and the median TRO (CSEMSs, 15.4 months vs USEMSs, 26.3 months; P  = .61). The adverse event rate was 27.5% for the CSEMS group and 27.7% for the USEMS group. Although tumor ingrowth with recurrent obstruction was more common in the USEMS group (76% vs 9%, P  < .001), stent migration (36% vs 2%, P  < .001) and acute pancreatitis (6% vs 1%, P  < .001) were more common in the CSEMS group. Limitations Retrospective study. Conclusions There was no significant difference in the patency rate or overall survival between CSEMSs and USEMSs for malignant distal biliary strictures. The CSEMS group had a significantly higher rate of migration and pancreatitis than the USEMS group. No significant SEMS-related adverse events were observed in patients undergoing neoadjuvant chemoradiation or surgical resection.