Suprapapillary Biliary Stents Have Longer Patency Times than Transpapillary Stents—A Systematic Review and Meta-Analysis

Abstract

Background and study aims: Endoscopic biliary stent placement is a minimally invasive intervention for patients with biliary strictures. Stent patency and function time are crucial factors. Suprapapillary versus transpapillary stent positioning may contribute to stent function time, so a meta-analysis was performed in this comparison. Methods: A comprehensive literature search was conducted in the CENTRAL, Embase, and MEDLINE databases to find data on suprapapillary stent placement compared to the transpapillary method via endoscopic retrograde cholangiopancreatography in cases of biliary stenosis of any etiology and any stent type until December 2020. We carried out a meta-analysis focusing on the following outcomes: stent patency, stent migration, rate of cholangitis and pancreatitis, and other reported complications. Results: Three prospective and ten retrospective studies involving 1028 patients were included. Suprapapillary stent placement appeared to be superior to transpapillary stent positioning in patency (weighted mean difference = 50.23 days, 95% CI: 8.56, 91.98; p = 0.0.018). In a subgroup analysis of malignant indications, suprapapillary positioning showed a lower rate of cholangitis (OR: 0.34, 95% CI: 0.13, 0.93; p = 0.036). Another subgroup analysis investigating metal stents in a suprapapillary position resulted in a lower rate of pancreatitis (OR: 0.16, 95% CI: 0.03, 0.95; p = 0.043) compared to transpapillary stent placement. There was no difference in stent migration rates between the two groups (OR: 0.67, 95% CI: 0.17, 2.72; p = 0.577). Conclusions: Based on our results, suprapapillary biliary stenting has longer stent patency. Moreover, the stent migration rate did not differ between the suprapapillary and transpapillary groups.

Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis

“…The major concern with uncovered stents remains the risk for obstruction by tumor ingrowth, resulting in recurrent cholangitis. For this reason, some groups have opted for new therapy modalities using plastic or intraductal papillary stents [32,33]. RFA has great potential in this regard, with results that demonstrated improved stent patency and improved patient survival.…”

Comparison of unilateral and bilateral intraductal plastic stent placement for unresectable malignant hilar biliary obstruction: A propensity score‐matched cohort analysis

“…23 Since the distal end of the PS is located in the CBD for IS placement, IS placement can reduce the risk of intestinal juice reflux and food impaction and has been reported to have long-term stent patency. [24][25][26][27] Kuwatani et al reported the possibility of bacteria entering the CBD via a PS thread. 28 In our study, PS without threads or nylon was used in only two cases in the unilateral group.…”

“…Stent sludge occlusion is one of the major reasons for RBO in PS and is related to bacterial biofilm formation due to intestinal juice reflux and food impaction 23 . Since the distal end of the PS is located in the CBD for IS placement, IS placement can reduce the risk of intestinal juice reflux and food impaction and has been reported to have long‐term stent patency 24–27 . Kuwatani et al.…”

Evaluating the Self-Expandable Metal Stents Placement in Malignant Biliary Obstruction: A Deeper Dive

“…For example, the anatomical variation of the patients, their overall comorbidities, previous antitumor therapy, or any other number of factors could be influencing the rate of duodenal invasion. 4 Without ruling out these confounding factors, we cannot conclusively say that it is the proximity to the AOV alone that is causing the higher rates of invasion.…”

“…The study seems to imply that the shortened stent patency in cases closer to the AOV is due to increased food retention and consequent reflux. 4,5 While this is a plausible theory, it remains just that-a theory-unless directly tested. At first glance, this explanation seems logical.…”