Related Experiment Video
Updated: Jun 26, 2026
07:44
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Covered Self-Expandable Metallic Stents versus Multiple Plastic Stents for Benign Biliary Strictures: A Systematic
Tarek Nayfeh1, Abdul Monaem Majzoub2, Tarek Aboursheid3
1Department of Medicine, MedStar Health Georgetown University (Baltimore) Internal Medicine Residency Program, Baltimore, Maryland, United States.
Avicenna Journal of Medicine
|June 25, 2026
Summary
Covered self-expandable metallic stents (CSEMS) show similar efficacy and safety to multiple plastic stents (MPS) for benign biliary strictures. CSEMS are more cost-effective, requiring fewer procedures and shorter treatment durations.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Biliary Interventions
Background:
- Benign biliary strictures (BBS) are a significant clinical challenge requiring effective stenting strategies.
- Multiple plastic stents (MPS) and covered self-expandable metallic stents (CSEMS) are used for BBS treatment, but direct comparisons are limited.
Purpose of the Study:
- To compare the efficacy, safety, and cost-effectiveness of MPS versus CSEMS in treating benign biliary strictures.
- To analyze outcomes including stricture resolution, recurrence, procedural success, and adverse events.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) published up to June 6, 2024.
- Included 7 RCTs with 594 adult patients diagnosed with BBS.
- Assessed study quality using the Cochrane Risk of Bias tool and employed a random-effects model for meta-analysis.
Main Results:
- CSEMS demonstrated comparable efficacy and safety to MPS in treating BBS.
- CSEMS required significantly fewer procedures (MD: -1.84) and stents (MD: -6.04).
- Treatment duration was shorter with CSEMS (MD: -119.02 days), and cost savings ranged from 41-57%.
Conclusions:
- CSEMS offer a cost-effective alternative to MPS for benign biliary strictures, with similar clinical outcomes.
- While evidence certainty is low to very low for most outcomes, moderate certainty supports technical success and stricture resolution.
- Future studies are needed to validate safety profiles and feasibility of CSEMS versus MPS.