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

Abstract

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.

Update on cholangiocarcinoma: potential impact of genomic studies on clinical management

“…In palliative cases, endoscopic treatment of malignant biliary strictures is usually performed with covered or uncovered self-expandable metal stents [60]. Additionally, intraductal photodynamic therapy can improve survival and biliary drainage as well as quality of life [61].…”

Self-expandable metallic stent placement above the papilla without endoscopic sphincterotomy in patients with distal malignant biliary obstruction

“…Endoscopic stent placement is an established palliative treatment for patients with distal malignant biliary obstruction (MBO), and self-expandable metallic stents (SEMS) have shown superiority over plastic stents in randomized trials [1,2]. Many comparative studies have evaluated covered vs. uncovered SEMS [3][4][5][6]. In these studies, SEMS were placed across the papilla.…”

Percutaneous Biliary External–Internal Drainage for Malignant Obstruction of Self-Expanding Uncovered Metal Stents Placed for Hilar Carcinoma: Retrospective Analysis of Long-Term Outcome in 160 Patients

“…3 In our practice, SEUMSs are preferred over plastic prostheses due to longer patency. 8,9 Although no statistically significant difference has been found in patency compared with uncovered stents, 10 covered stents are not indicated in hilar obstructions because they do not allow leftright lobe communication, as do stents with open meshes. In this setting, we chose to insert an external-internal biliary drain rather than a new stent to ensure long-term definitive drainage because in case of eventual reobstruction, additional metallic stents across the hilum would increase the complexity of drainage maneuvers and surely in some cases result in failure of the internal drainage.…”