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Management of occluded metal stents in malignant biliary obstruction: similar outcomes with second metal stents compared to plastic stents.

Publication ,  Journal Article
Shah, T; Desai, S; Haque, M; Dakik, H; Fisher, D
Published in: Dig Dis Sci
November 2012

BACKGROUND: Covered or uncovered self expandable metallic stents (SEMS) placed in patients with malignant biliary obstruction can occlude in 19-40 %, but optimal management is unclear. AIM: We sought to summarize current evidence regarding management of occluded SEMS in patients with malignant biliary obstruction. METHODS: Two investigators independently searched Pubmed, Embase, and Web of Science using pre-defined search criteria, and reviewed bibliographies of included studies. Data were independently abstracted by two investigators, and analyzed using RevMan. We compared strategies of second SEMS versus plastic stents with respect to the following outcomes: rate of second stent re-occlusion, duration of second stent patency, and survival. RESULTS: Ten retrospective studies met inclusion criteria for the systematic review. Management options described were placement of an uncovered SEMS (n = 125), covered SEMS (n = 106), plastic stent (n = 135), percutaneous biliary drain (n = 7), mechanical cleaning (n = 18), or microwave coagulation (n = 7). Relative risk of re-occlusion was not significantly different in patients with second SEMS compared to plastic stents (RR 1.24, 95 % CI 0.92, 1.67, I(2) = 0, p 0.16). Duration of second stent patency was not significantly different between patients who received second SEMS versus plastic stents (weighted mean difference 0.46, 95 % CI -0.30, 1.23, I(2) = 83 %). Survival was not significantly different among patients who received plastic stents versus SEMS (weighted mean difference -1.13, 95 % CI -2.33, 0.07, I(2) 86 %, p = 0.07). CONCLUSIONS: Among patients with malignant biliary obstruction and occluded SEMS, available evidence suggests a strategy of placing a plastic stent may be as effective as second SEMS. Limitations of these findings were that all studies were retrospective and heterogeneity between studies was detected for two of the outcomes.

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Published In

Dig Dis Sci

DOI

EISSN

1573-2568

Publication Date

November 2012

Volume

57

Issue

11

Start / End Page

2765 / 2773

Location

United States

Related Subject Headings

  • Stents
  • Plastics
  • Outcome Assessment, Health Care
  • Metals
  • Jaundice, Obstructive
  • Humans
  • Gastroenterology & Hepatology
  • Common Bile Duct Neoplasms
  • Cholestasis, Extrahepatic
  • Cholangiopancreatography, Endoscopic Retrograde
 

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Shah, T., Desai, S., Haque, M., Dakik, H., & Fisher, D. (2012). Management of occluded metal stents in malignant biliary obstruction: similar outcomes with second metal stents compared to plastic stents. Dig Dis Sci, 57(11), 2765–2773. https://doi.org/10.1007/s10620-012-2272-7
Shah, Tilak, Svetang Desai, Mahfuzul Haque, Hassan Dakik, and Deborah Fisher. “Management of occluded metal stents in malignant biliary obstruction: similar outcomes with second metal stents compared to plastic stents.Dig Dis Sci 57, no. 11 (November 2012): 2765–73. https://doi.org/10.1007/s10620-012-2272-7.
Shah, Tilak, et al. “Management of occluded metal stents in malignant biliary obstruction: similar outcomes with second metal stents compared to plastic stents.Dig Dis Sci, vol. 57, no. 11, Nov. 2012, pp. 2765–73. Pubmed, doi:10.1007/s10620-012-2272-7.
Journal cover image

Published In

Dig Dis Sci

DOI

EISSN

1573-2568

Publication Date

November 2012

Volume

57

Issue

11

Start / End Page

2765 / 2773

Location

United States

Related Subject Headings

  • Stents
  • Plastics
  • Outcome Assessment, Health Care
  • Metals
  • Jaundice, Obstructive
  • Humans
  • Gastroenterology & Hepatology
  • Common Bile Duct Neoplasms
  • Cholestasis, Extrahepatic
  • Cholangiopancreatography, Endoscopic Retrograde