Covered and uncovered biliary metal stents provide similar relief of biliary obstruction during neoadjuvant therapy in pancreatic cancer: a randomized trial

Abstract

R. (2019). Covered and uncovered biliary metal stents provide similar relief of biliary obstruction during neoadjuvant therapy in pancreatic cancer: A randomized trial. Gastrointestinal Endoscopy.

Endoscopic retrograde cholangiopancreatography guided interventions in the management of pancreatic cancer

“…As such in this scenario, partially-covered SEMS are preferred over fully-covered SEMS particularly as lesions become more proximal, as partially-covered SEMS would allow effective drainage of the intrahepatic side branches through fenestrations of uncovered portions of the stent. Multiple RCT and retrospective studies have shown the superiority of uncovered SEMS over covered SEMS for long-term stent patency, however no significant difference in patency between two SEMS after 6 and 12 mo, and no difference in patient survival or complication rates such as pancreatitis, cholangitis, cholecystitis, perforation, bleeding, length of hospital stay, and incidence of recurrent biliary obstruction (Table 4 )[ 47 , 88 - 106 ]. Taken together, uncovered SEMS are associated with higher rates of stent dysfunction due to tumor ingrowth whereas covered SEMS have a higher rate of stent migration and a lower risk of sludge-mediated occlusion (Table 4 )[ 47 , 88 - 106 ].…”

“…Multiple RCT and retrospective studies have shown the superiority of uncovered SEMS over covered SEMS for long-term stent patency, however no significant difference in patency between two SEMS after 6 and 12 mo, and no difference in patient survival or complication rates such as pancreatitis, cholangitis, cholecystitis, perforation, bleeding, length of hospital stay, and incidence of recurrent biliary obstruction (Table 4 )[ 47 , 88 - 106 ]. Taken together, uncovered SEMS are associated with higher rates of stent dysfunction due to tumor ingrowth whereas covered SEMS have a higher rate of stent migration and a lower risk of sludge-mediated occlusion (Table 4 )[ 47 , 88 - 106 ]. Overall, no difference was observed in the rates of pancreatitis and cholecystitis between covered and uncovered SEMS[ 47 , 88 - 106 ].…”

“…Taken together, uncovered SEMS are associated with higher rates of stent dysfunction due to tumor ingrowth whereas covered SEMS have a higher rate of stent migration and a lower risk of sludge-mediated occlusion (Table 4 )[ 47 , 88 - 106 ]. Overall, no difference was observed in the rates of pancreatitis and cholecystitis between covered and uncovered SEMS[ 47 , 88 - 106 ].…”

“…ERCP-PBD using covered SEMS is preferred over uncovered SEMS and plastic stents because of a decreased risk of stent dysfunction and longer stent patency[ 6 ]. In a recent RCT, Seo et al[ 106 ] have shown comparable success rates of covered and uncovered SEMS in pancreatic cancer patients undergoing PBD before and after neoadjuvant therapy, however, covered SEMS were suggested to be superior in cases of diagnosis uncertainty. If a biliary stricture turns out to be malignant, there is no need to replace covered SEMS with uncovered SEMS because risk of stent dysfunction due to tumor ingrowth is negligible.…”

“…If a biliary stricture turns out to be malignant, there is no need to replace covered SEMS with uncovered SEMS because risk of stent dysfunction due to tumor ingrowth is negligible. Shorter stent lengths (4 cm as opposed to 6 or 8 cm) and the presence of an in situ gallbladder were significant predictors associated with failure to attain prolonged biliary drainage with a hazard ratio of 2.1 and 6.9[ 106 ]. The type of stent selection should be individualized based on these factors.…”