Status evaluation: biliary stents. American Society for Gastrointestinal Endoscopy. Technology Assessment Committee

Area of Science:

• Gastroenterology and Hepatology
• Interventional Endoscopy

Background:

• Large caliber plastic stents (10-11.5 Fr) are standard for malignant and benign biliary strictures.
• Current plastic stents have early complication rates of 8-10% and mortality of ~2%.

Purpose of the Study:

• To review the efficacy and limitations of plastic stents in biliary tract treatment.
• To discuss the potential role and challenges of expandable metal stents.

Main Methods:

• Review of existing literature on plastic and metal stent patency in biliary applications.
• Analysis of complication rates, clogging mechanisms, and long-term outcomes.

Main Results:

• Plastic stents require replacement every 4-6 months in 20-35% of patients due to clogging.
• Despite large diameters, metal stents face issues like tumor ingrowth and lack of randomized trial data.

Conclusions:

• Plastic stent patency remains limited by clogging, with no current clinical improvements.
• Expandable metal stents are not yet recommended due to technical challenges, cost, and insufficient evidence.