Comparative efficacy of various stents for palliation in patients with malignant extrahepatic biliary obstruction: A systematic review and network meta-analysis

Chan Hyuk Park, Se Woo Park, Jang Han Jung, Eun Suk Jung, Jung Hee Kim, Da Hae Park

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Although many studies have investigated the efficacy of stent placement for patients with malignant extrahepatic biliary obstruction, the clinical outcomes and adverse events of biliary stent-ing have not been comprehensively evaluated. We searched all relevant randomized-controlled trials that evaluated the comparative efficacy of biliary stents, including the plastic stents, uncovered self-expandable metal stents (SEMSs), and covered SEMSs in patients with malignant extrahepatic biliary obstructions. Twenty-one studies with 2326 patients were included. Both uncovered and covered SEMSs had a lower risk of recurrent biliary obstruction (RBO) compared to plastic stents (risk ratio (RR) (95% confidence interval [CI]): uncovered vs. plastic, 0.46 (0.35–0.62); covered vs. plastic, 0.46 (0.34–0.62)). A comparison of the groups using SEMSs revealed that tumor ingrowth was common in the uncovered SEMS group, while stent migration, tumor overgrowth, and occlu-sion by sludge were common in the covered SEMS group; however, the overall risk of RBO did not differ between these groups (RR (95% CI): uncovered vs. covered: 1.02 (0.80–1.30)). Although the main causes of RBO vary across stents, RBO risk was similar between uncovered and covered SEMS groups. Both SEMSs have superior efficacy in terms of RBO compared to plastic stents.

Original languageEnglish
Article number86
Pages (from-to)1-20
Number of pages20
JournalJournal of Personalized Medicine
Volume11
Issue number2
DOIs
StatePublished - 2021 Jan

Keywords

  • Malignant biliary obstruction
  • Metal stent
  • Plastic stent
  • Recurrent biliary obstruction
  • Stent

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