Endoscopic Drainage- Plastic Versus Metal Stent in Palliative Treatment of Malignant Distal Biliary Obstruction: a Systematic Review and Meta-Analysis

Aims Bile duct tumors are no curative in most cases. Endoscopic biliary drainage is considered the gold standard for palliative treatment of unresectable and/or inoperable distal malignant distal biliary obstruction (MDBO). This meta-analysis aims to compare plastic stent (PS) versus metal stent (SEMS) in the palliative treatment of MDBO and evaluate which one has the greatest benefit.

Methods A comprehensive literature search was made from the Medline (PUBMED), Central Cochrane Library, EMBASE, LILACS and gray research, selecting only randomized clinical trials (RCTs). Assessed outcomes were: duration patency, stent dysfunction rate, reintervention rate, clinical success, median survival and complications.

Results 12 RCTs with 1005 patients met the inclusion criteria. The SEMS group was divided into three subgroups, uncovered metal stent (uSEMS), partially/fully covered (pcSEMS/cSEMS) and the group in which the SEMS was not specified (SEMSns). SEMS had a lower dysfunction rate than the PS ([Table 1]) and in the analysis of the subgroups, uSEMS had no difference comparing to PS (RD =-0.08, 95 %CI = -0.56;0.39, p = 0.006, I²=87 %) and pcSEMS/cSEMS was higher (RD = -0.21, 95 %CI = -0.32; -0.1, p = 0.0003, I²=20 %). Regarding reintervention, dichotomous and continuous variables were evaluated, but in both SEMS had a lower reintervention rate compared to PS ([Table 1]). Concerning duration of patency, SEMS also showed advantage than PS ([Table 1]). In the three subgroups of the SEMS there was longer duration of patency (uSEMS presented RD=101.5,95 %CI=38.91;164.09,I²=98 %, pcSEMS/cSEMS presented RD=152.25,95 %CI= 37.42;267.07,p<0.00001,I²=98 % and SEMSns presented RD=105.81,95 %CI=33.01;178.60,p<0.00001,I²=95 %). In the mean survival analysis, there was no difference between SEMS and PS (MD=0.63, 95 %CI=-18.07;19.33), however, in the analysis of the subgroups, pcSEMS/cSEMS favored over the PS (MD =-17.45,95 %CI =-32.68;-2.21,p=0,02;I²=5 %). Regarding complications and clinical success there was no difference.

Tab. 1 Synthesis of results for each outcome

OUTCOMES	OVERALL ANALYSIS	OUTCOMES	OVERALL ANALYSIS
Stent dysfunction	RD= -0.24, 95 % CI= -0.33; -0.15, p < 0.00001, I2= 58 %	Duration of patency	MD= 125.77, 95 % CI= 77.5; 174.01, p< 0.00001, I2= 97 %
Reinterventions (dichotomous)	RD= -0.34, 95 % CI= -0.46; -0.22, p<0.00001, I2= 57 %	Complications	RD= -0.03, 95 % CI= -0.10; 0.03, p= 0.26
Reinterventions (continuos)	MD= -0.67, 95 % CI= -0.85; -0.50, p<0.00001, I2= 0 %	Mean survival	MD= 0.63, 95 % CI= -18.07;19.33, p= 0.95, I2= 59 %
Clinical sucess	RD= 0.03, 95 % CI = -0.01; 0.07, p= 0.19, I2= 0 %

Conclusions SEMS has a longer duration of patency, lower reintervention rate and lower dysfunction rate compared to PS. Concerning clinical success, survival and clinical complications, there were no difference.

Citation: Cury Vieira Scatimburgo MV, Braga Ribeiro I, Massari Takamatsu Sagae V et al. OP133 ENDOSCOPIC DRAINAGE- PLASTIC VERSUS METAL STENT IN PALLIATIVE TREATMENT OF MALIGNANT DISTAL BILIARY OBSTRUCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS Endoscopy 2021; 53: S55.

Publication History

Article published online:
19 March 2021