A Randomized Controlled Comparative Study of Covered Versus Uncovered Self-Expandable Metal Stent for Malignant Biliary Obstruction

Lee, S.H.; Woo, Sang Myung; Cheon, Young Koog; Kim, Y.; Moon, Jiwon; Cho, Y.D.; Kim, Y.S.; Lee, J.S.; Lee, M.S.; Shim, Chan Sup; Kim, Boo Sung

doi:10.1016/s0016-5107(04)00880-6

Cited by 10 publications

(4 citation statements)

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“…By contrast, there was no effect on overall survival. The stent patency durations in our study were relatively shorter than in other reports [11][12][13][14][15]. These results might reflect the fact that only patients with an advanced stage of malignancy were enrolled and were followed for a period sufficient to assess stent patency.…”

Section: Discussioncontrasting

confidence: 54%

A prospective randomized study for efficacy of an uncovered double bare metal stent compared to a single bare metal stent in malignant biliary obstruction

et al. 2016

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Section: Discussioncontrasting

confidence: 54%

A prospective randomized study for efficacy of an uncovered double bare metal stent compared to a single bare metal stent in malignant biliary obstruction

et al. 2016

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“…A total of 1417 patients (700 with UCSEMSs and 717 with CSEMSs) were enrolled in the 7 full-text trials [ 12 – 16 , 25 , 26 ] and 7 abstract trials [ 18 , 27 – 32 ] (Tables 1 and 2 ). Pancreatic cancer and bile duct carcinoma were the two main reasons for malignant biliary obstruction.…”

Section: Resultsmentioning

confidence: 99%

“…Pancreatic cancer and bile duct carcinoma were the two main reasons for malignant biliary obstruction. Furthermore, 739 patients with pancreatic cancer and 156 patients with bile duct cancer were enrolled in 9 trials [ 12 – 16 , 18 , 25 , 26 , 31 ]. In 10 studies [ 12 – 14 , 18 , 26 , 27 , 29 – 32 ], stent placement was performed via an endoscope, and in 3 trials [ 15 , 16 , 25 ], the stents were inserted using a percutaneous approach.…”

Section: Resultsmentioning

confidence: 99%

Covered versus Uncovered Self-Expandable Metal Stents for Managing Malignant Distal Biliary Obstruction: A Meta-Analysis

Sun

et al. 2016

PLoS ONE

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AimTo compare the efficacy of using covered self-expandable metal stents (CSEMSs) and uncovered self-expandable metal stents (UCSEMSs) to treat objective jaundice caused by an unresectable malignant tumor.MethodsWe performed a comprehensive electronic search from 1980 to May 2015. All randomized controlled trials comparing the use of CSEMSs and UCSEMSs to treat malignant distal biliary obstruction were included.ResultsThe analysis included 1417 patients enrolled in 14 trials. We did not detect significant differences between the UCSEMS group and the CSEMS group in terms of cumulative stent patency (hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.19–4.53; p = 0.93, I2 = 0%), patient survival (HR 0.77, 95% CI 0.05–10.87; p = 0.85, I2 = 0%), overall stent dysfunction (relative ratio (RR) 0.85, M-H, random, 95% CI 0.57–1.25; p = 0.83, I2 = 63%), the overall complication rate (RR 1.26, M-H, fixed, 95% CI 0.94–1.68; p = 0.12, I2 = 0%) or the change in serum bilirubin (weighted mean difference (WMD) -0.13, IV fixed, 95% CI 0.56–0.3; p = 0.55, I2 = 0%). However, we did detect a significant difference in the main causes of stent dysfunction between the two groups. In particular, the CSEMS group exhibited a lower rate of tumor ingrowth (RR 0.25, M-H, random, 95% CI 0.12–0.52; p = 0.002, I2 = 40%) but a higher rate of tumor overgrowth (RR 1.76, M-H, fixed, 95% CI 1.03–3.02; p = 0.04, I2 = 0%). Patients with CSEMSs also exhibited a higher migration rate (RR 9.33, M-H, fixed, 95% CI 2.54–34.24; p = 0.008, I2 = 0%) and a higher rate of sludge formation (RR 2.47, M-H, fixed, 95% CI 1.36–4.50; p = 0.003, I2 = 0%).ConclusionsOur meta-analysis indicates that there is no significant difference in primary stent patency and stent dysfunction between CSEMSs and UCSEMSs during the period from primary stent insertion to primary stent dysfunction or patient death. However, when taking further management for occluded stents into consideration, CSEMSs is a better choice for patients with malignant biliary obstruction due to their removability.

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“…Two studies, a retrospective one in Japan [8] and a prospective one in France [9] reported the efficacy of covered SEMS in distal malignant biliary obstruction ( Table 1). A third randomized and prospective comparative study by Lee et al showed that the patency duration was longer with covered SEMS in comparison with uncovered SEMS (216 days vs. 127 days; P < 0.05) [10]. In conclusion, covered SEMS appear to offer better palliation for distal malignant biliary obstruction, although there is a risk of cholecystitis and stent migration.…”

Section: Malignant Biliary Diseasementioning

confidence: 87%

Endoscopic Retrograde Cholangiopancreatography

Arvanitakis

Devière

2004

Endoscopy

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IntroductionEndoscopic retrograde cholangiopancreatography (ERCP) is still the subject of intensive clinical research. This year, new data were presented during the Digestive Disease Week (DDW) on biliary stenting, as well as ERCP-associated complications and methods of prevention. In addition, several abstracts discussed the use of combined ERCP and endoscopic ultrasonography (EUS) techniques for diagnostic and therapeutic management in biliary and pancreatic diseases. This review highlights the most relevant studies, which will be reported in detail. The remaining abstracts are cited as references, and in some cases summarized in the tables. Benign Biliary DiseaseRemoval of common bile duct (CBD) stones can be achieved following either biliary sphincterotomy or endoscopic papillary balloon dilation (EPBD). A meta-analysis by Baron and Harewood summarized eight randomized controlled trials (including a total of 1106 patients), comparing the two techniques for CBD stone removal with regard to success rates and complication rates [1]. EPBD and biliary sphincterotomy resulted in similar outcomes with regard to overall successful stone removal (94.3 % vs. 96.5 %) and overall complications (10.5 % vs. 10.3 %). However, bleeding occurred less frequently with EPBD (0 % vs. 2 %; P = 0.001), whereas post-ERCP pancreatitis occurred more commonly in the EPBD group (7.4 % vs. 4.3 %; P = 0.05). Patients undergoing EPBD were also more likely to require mechanical lithotripsy for stone extraction (20.9 % vs. 14.8 %; P = 0.014). On the basis of these results, EPBD should be the strategy of choice over biliary sphincterotomy for endoscopic removal of CBD stones in patients with coagulopathy, although it cannot be routinely recommended. A second meta-analysis by Weinberg et al., summarizing 13 randomized controlled trials, confirmed these results [2]. Finally, a study compared EPBD vs. biliary sphincterotomy for CBD stones in liver cirrhosis patients with coagulopathy, showing a lower rate of bleeding and no significant difference with regard to post-ERCP pancreatitis [3].An interesting retrospective study by Costamagna's group assessed the role of extracorporeal shock-wave lithotripsy (ESWL) associated with ERCP in the endoscopic management of intrahepatic lithiasis in 129 patients [4]. Of 215 patients presenting with intrahepatic lithiasis, 76 underwent ERCP with stone extraction, and the remaining 129 had combined ERCP and ESWL. Combined therapy with ESWL appeared to be more successful for complete stone removal (53.9 % vs. 75.9 %; P < 0.05).Endoscopic biliary stenting is the optimal nonsurgical therapy for biliary leaks resulting from trauma or occurring postoperatively. Escalante-Glorsky and colleagues investigated endoscopic therapy in extrahepatic (n = 206) and intrahepatic biliary leakage (n = 27) [5]. Treatment included biliary sphincterotomy and placement of a 7 ± 10-Fr straight polyethylene stent to bypass the site of leakage, or within the leaking intrahepatic duct. Success rates relative to healing were 94 % for extr...

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A Randomized Controlled Comparative Study of Covered Versus Uncovered Self-Expandable Metal Stent for Malignant Biliary Obstruction

Cited by 10 publications

References 0 publications

A prospective randomized study for efficacy of an uncovered double bare metal stent compared to a single bare metal stent in malignant biliary obstruction

A prospective randomized study for efficacy of an uncovered double bare metal stent compared to a single bare metal stent in malignant biliary obstruction

Covered versus Uncovered Self-Expandable Metal Stents for Managing Malignant Distal Biliary Obstruction: A Meta-Analysis

Endoscopic Retrograde Cholangiopancreatography

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