Endoscopic stenting for inoperable malignant biliary obstruction: A systematic review and meta-analysis

Area of Science:

• Gastroenterology and Hepatology
• Interventional Endoscopy
• Oncology

Background:

• Malignant biliary obstruction presents a significant challenge in palliative care.
• Stent placement is a common intervention, with various types available.
• Comparative effectiveness data for different stent types in this setting are crucial.

Purpose of the Study:

• To conduct a meta-analysis comparing self-expanding metal stents (SEMS) and plastic stents (PS) for inoperable malignant biliary obstruction.
• To evaluate key outcomes including stent dysfunction, complications, re-intervention rates, survival, patency, and costs.

Main Methods:

• Systematic review and meta-analysis of randomized clinical trials (RCTs) updated to March 2015.
• Inclusion of data from multiple databases and gray literature.
• Assessment of risk differences for dichotomous outcomes and mean differences for continuous outcomes using RevMan software.

Main Results:

• Thirteen RCTs involving 1133 patients were meta-analyzed.
• SEMS demonstrated significantly lower stent dysfunction (21.6% vs 46.8%) and re-intervention rates (21.6% vs 56.6%) compared to PS.
• No significant differences were observed in complication rates (13.7% vs 15.9%).
• SEMS group showed improved survival (182 vs 150 days), longer patency (250 vs 124 days), and a trend towards lower costs.

Conclusions:

• Self-expanding metal stents (SEMS) are superior to plastic stents (PS) in reducing stent dysfunction and re-interventions for malignant biliary obstruction.
• SEMS are associated with improved patient survival and longer stent patency.
• While complications and costs did not differ significantly, the functional benefits favor SEMS.