Published online May 27, 2021. doi: 10.4240/wjgs.v13.i5.493
Peer-review started: January 24, 2021
First decision: March 29, 2021
Revised: March 30, 2021
Accepted: April 23, 2021
Article in press: April 23, 2021
Published online: May 27, 2021
Processing time: 116 Days and 10 Hours
The drainage endoscopic in patients with inoperable and/or irresectable malignant distal biliary obstruction (MDBO) has several advantages such as patient comfort, increased survival and fewer complications due to biliary obstruction. However, there are two types of stents, self-expanding metal stent (SEMS) and plastic stent (PS), leading to much discussion about which one to use, due to their different characteristics.
In many cases, MDBO have no curative perspective by the time of diagnosis. Therefore, palliative treatment for bile duct clearance plays a major role, since they provide longer life expectancy and better quality of life. Therefore, we wanted to compare the two types of stents commonly used in an attempt to understand which approach is best.
To perform a systematic review and meta-analysis of Randomized Controlled Trials comparing plastic vs metal stents in palliative treatment of MDBO.
We performed a systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Electronic searches were performer using MEDLINE, EMBASE, Central Cochrane, Latin American and Caribbean Health Sciences Literature databases. Only randomized control trials were included. The outcomes studied were stent dysfunction rate, reintervention rate, duration of patency, mean survival, complications, and clinical success.
Twelve randomized clinical trials were included in the final analysis with a total of 1005 patients, of whom 681 belonged to the SEMS group and 542 to the PS group. 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 (SEMS not specified). SEMS had a lower dysfunction rate than the PS and in the analysis of the subgroups, uSEMS had no difference comparing to PS and pcSEMS/cSEMS was higher. Regarding reintervention, SEMS had a lower reintervention rate compared to PS. Concerning duration of patency, SEMS also showed advantage than PS. In the three subgroups of the SEMS, there was longer duration of patency. In the mean survival analysis, there was no difference between SEMS and PS, however, in the analysis of the subgroups, pcSEMS/cSEMS favored over the PS. Regarding complications rate and clinical success were similar in both groups, and have no significant difference.
Our study showed that SEMS presents a higher duration of patency, lower reintervention rate, and lower dysfunction rate when compared to the use of PS. There was no difference between the methods in concern of survival analysis, clinical success and rate of complications.
The use of SEMS was a great advent in palliative therapy for MDBO. In our study, the use of SEMS revealed even more benefits in most cases. We hope that this study can clarify its benefit and that more patients can be benefited in deciding the type of stent used from here.