Percutaneous Self-expanding Metal Stents versus Endoscopic Polyethylene Endoprostheses for Treating Malignant Biliary Obstruction: Randomized Clinical Trial

Abstract

Placement of a percutaneous self-expanding metal stent is an alternative to placement of an endoscopic polyethylene endoprosthesis in patients with malignant biliary obstruction.

Percutaneous biliary stenting combined with radiotherapy as a treatment for unresectable hilar cholangiocarcinoma

“…The Cox regression analysis performed in this study revealed that percutaneous biliary stenting was the only independent predictor of survival. These results indicated that, although it exhibited a high rate of complications, percutaneous biliary stenting is more suitable for patients with malignant hilar biliary obstruction (10).…”

“…The relevant literature reported that the rate of successful biliary drainage, early complications and stent obstruction in malignant hilar biliary obstruction were extremely similar to those in hilar cholangiocarcinoma (5,14,15). A previous randomized trial compared the success rate of biliary drainage, complications and overall median survival between percutaneous and endoscopic stenting for malignant hilar biliary obstruction (10). In the percutaneous group, the clinical success was increased (71 vs. 42%; P= 0.03), the rate of complications was higher (61 vs. 35%; P= 0.09) and the overall median survival was significantly longer (3.7 vs. 2 months; P=0.02).…”

“…However, the risk of complications of percutaneous biliary stenting was increased compared with the risks of endoscopic biliary stenting (10). By contrast, the bile duct consists of isolated segments and not all of the bile ducts come together, so only an uncovered metallic stent may achieve full biliary drainage.…”

Pancreato-Biliary Cancers – Diagnosis and Management

“…Percutaneous trans-hepatic stenting (PTHS) is often reserved for patients in whom ERCP has failed due to a higher complication rate as well as poorer quality of life (Pinol et al, 2002). More recently, the advent of EUS assisted ductal drainage and stenting has significantly improved the success rate of endoscopic approach and thus, reduced the need for PTHS.…”

Cost-Effectiveness Decision Analyses Comparing Covered to Uncovered Self-Expandable Metal Stents to Elective or on Demand Polyethylene Stent Changes in Patients with Distal Malignant Biliary Obstruction

“…A collection of published series done by Coene et al supports the superiority of an endoscopic versus a percutaneous approach with regards to early complication, 30-day mortality and successful drainage [96]. However, a recent RCT showed that patients undergoing percutaneous drainage had a longer survival than those in the endoscopy group, which conflicts with results from trials performed 2 decades ago [97]. The authors argued that advances in radiological techniques have led to a reduction in complication rates, and that the results from 'old' studies do not reflect current practice.…”