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Updated: Aug 8, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Covered metal versus plastic stents for malignant common bile duct stenosis: a prospective, randomized, controlled
Claes Soderlund1, Stefan Linder
1Karolinska Institutet, Upper GI Surgery, Department of Surgery, South Hospital, SE 118-83 Stockholm, Sweden.
Background:
Most patients with malignant common bile duct strictures are suited only for palliation of jaundice by placement of a polyethylene (PE) stent using an endoscopic retrograde cholangiographic technique. Occlusion of these stents occurs after 3 to 4 months, whereas uncovered self-expanding metal stents (SEMS) remain open twice as long. The initial higher cost of the latter might be balanced by a decreased need for repeat intervention.
Objective:
To compare the patency of 10F PE stents and covered 30F steel SEMS (Wallstent; Boston Scientific Nordic AB, Helsingborg, Sweden).
Design:
Single-center, prospective, randomized, controlled trial.
Setting:
General hospital in Stockholm, Sweden, which has a catchment area of 0.6 million people.
Patients:
Non-referred, unresectable malignant common bile duct strictures.
Interventions:
Endoscopic retrograde cholangiography with plastic stents or covered SEMS.
Main Outcome Measurements:
Time to stent failure, requiring a new stent.
Limitations:
Similar setting and patients, and costs in Scandinavia.
Results:
Fifty-one and 49 patients were allocated to the PE stent and SEMS groups, respectively. Fifty-six patients died without stent failure within 10 months (median, 2.6 months). Twenty-two PE stent and 9 SEMS patients (P = .009) developed failure after a median of 1.1 and 3.5 months, respectively (P = .007). Median patency times were 1.8 and 3.6 months in the PE and SEMS groups, respectively (P = .002). Median survival was 4.5 months; in 35 patients with distant metastases, the median survival was 2.5 months (P = .002)(PE group, 1.9 months).
Conclusions:
The more-effective SEMS are recommended in unresectable patients with malignant common bile duct strictures, who survive a median of 4.5 months. Less costly plastic stents are preferable in the one third of patients who have distant metastases. In our study, the cost was equal.