Fully Covered Self-Expanding Metal Stent vs Multiple Plastic Stents to Treat Benign Biliary Strictures Secondary to Chronic Pancreatitis: A Multicenter Randomized Trial

Metal versus plastic stents in the management of benign biliary strictures: systematic review and meta-analysis of randomized controlled trials

“…Another issue with CSEMS is that they may sometimes be difficult to remove due to the ingrowth of hyperplastic tissue. In the RCT by Ramchandani et al [9], stent removal was difficult in seven patients and required insertion of an inner FCSEMS to obtain pressure necrosis of the hyperplastic tissue embedding the stent edges. Haapamaki et al [14] found that CSEMS removal was problematic in four patients; stents broke in three and, in one patient, stent removal required several ERCP sessions and placement of another CSEMS inside the first one.…”

“…The stent indwell time for CSEMS, which varied across the studies that we included, was 6 months in most of them. The longest indwell time was in the RCT by Ramchandani et al (1 year) [9]. The ideal stent indwell time to achieve optimal results is unknown.…”

“…We also performed subgroup analyses including studies that used fully covered self-expandable metal stents (FCSEMS) only. One of the studies [9] had substantially longer stent indwell time (12 months) in the CSEMS group compared to other studies. We performed a sensitivity analysis by excluding this study.…”

“…One previous meta-analysis, including several single-arm observational studies, reported stricture resolution and recurrence rates of 83 and 16%, respectively, with CSEMS [6][7][8]. Several randomized controlled trials (RCTs) have compared MPS with CSEMS in the management of BBS and have reported favorable results with CSEMS [9]. In this systematic review and meta-analysis, we have pooled all published RCTs to date to compare the efficacy and safety of CSEMS and MPS in the management of BBS.…”

The Race to Resolution of Benign Biliary Strictures: Slow and Steady vs Pedal to the Covered Metal?

“…Clinical translation has been impeded by a number of factors, including the complexity of target selection because of extensive intra-and intertumoral genetic heterogeneity, 5 discrepancies in the addiction of different tumor types to the same oncogenic driver, 6 and the frequent occurrence of tumor adaptation and development of resistance to molecular targeted therapies. 7 In this issue of Gastroenterology, Inoue et al 8 attempt to address and circumvent some of these issues in their search for novel targeted therapy approaches for CRC. Using a combination of targeted RNA interface screens in CRC patient-derived xenografts (PDX) and drug screens in cell cultures derived from the same tumors, they identify Exportin 1 (XPO1) as a CRC cell intrinsic gene dependency and novel potential therapeutic target in this disease.…”