Related Experiment Video
Updated: Jul 4, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Comparison of fully covered self-expandable metal biliary stents with or without anchoring double-pigtail plastic
Samuel Tanner1, Fadi Hawa2, Alejandra Vargas3
1Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
Background And Aims:
Fully covered self-expandable metal stents (FcSEMSs) have become the mainstay of treatment for a variety of biliary pathologies. However, FcSEMSs have been associated with a greater rate of stent migration than other types of stents. A technique of anchoring double-pigtail plastic stents (DPPSs) has been proposed to minimize migration of biliary FcSEMSs. Herein, we evaluated the efficacy of anchoring DPPSs among patients treated with biliary FcSEMSs.
Methods:
We performed a systematic review using PubMed, EMBASE, and Web of Science from database inception through August 2023. Full-text articles comparing FcSEMSs with or without anchoring DPPSs were included. We evaluated the following outcomes: (1) stent migration; (2) stent occlusion; (3) duration of stent patency; (4) cholangitis; (5) unplanned reinterventions; and (6) adverse events. Meta-analysis was carried out using random-effect models and reported as odds ratios (ORs) with corresponding 95% confidence intervals (95% CIs).
Results:
Four studies encompassing 489 patients were included. Patients with anchoring DPPSs had a 67% reduction in FcSEMS migration compared with those without anchoring DPPSs (OR: 0.33; 95% CI, 0.19-0.57; I 2 0%). Anchoring DPPSs increased the mean duration of FcSEMS patency by 83 days compared with FcSEMSs alone (95% CI, 46-120; I 2 94%). No differences in other clinical end points or adverse events were observed.
Conclusions:
Anchoring DPPSs reduced the risk of FcSEMS migration and increased the duration of FcSEMS patency without an increased risk of adverse events. Future studies are needed to corroborate these findings, determine the optimal DPPS technique, and to compare DPPS placement with other antimigratory modalities.
