Yasunobu Yamashita1, Ayaka Tachikawa1, Toshio Shimokawa2, Hirofumi Yamazaki1, Masahiro Itonaga1, Yuji Sakai3, Harutoshi Sugiyama3, Yousuke Nakai4,5, Kiyohito Tanaka6, Hiroyuki Isayama7, Masayuki Kitano1. 1. Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan. 2. Clinical Study Support Center, Wakayama Medical University Hospital, Wakayama, Japan. 3. Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan. 4. Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan. 5. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 6. Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan. 7. Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
Abstract
OBJECTIVES: The role of a covered vs. an uncovered self-expandable metal stent (SEMS) for malignant distal biliary obstruction (MDBO) is not clear. This meta-analysis compared the efficacy of covered vs. uncovered SEMS for patients with MDBO after endoscopic insertion. METHODS: A systematic meta-analysis of all relevant articles listed in PubMed, the Cochrane Library, and Google Scholar databases was performed. Fixed effects or random effects models were used to investigate pooled effects with 95% confidence intervals (CIs). RESULTS: The meta-analysis included 2358 patients from 12 eligible studies. Time to recurrent biliary obstruction (RBO) was significantly longer for covered SEMS (mean difference, 45.51 days; 95% CI 11.79-79.24). Although there was no significant difference in the RBO rate, subgroup analysis in pancreatic cancer occupying more than 90% (PC) revealed that the RBO rates were significantly lower for covered SEMS (odds ratio [OR] 0.43, 95% CI 0.25-0.74). Stent migration, sludge formation, and overgrowth were significantly more common with a covered SEMS (OR 7.92, 95% CI 4.01-15.64; OR 3.25, 95% CI 1.89-5.59; OR 2.03, 95% CI 1.20-3.43, respectively). The rate of ingrowth was significantly lower for covered SEMS. There was no significant difference in total procedure-related adverse events between the two types of SEMS. CONCLUSIONS: A covered SEMS is superior to an uncovered SEMS with respect to prevention of RBO in patients with MDBO, particularly those caused by PC.
OBJECTIVES: The role of a covered vs. an uncovered self-expandable metal stent (SEMS) for malignant distal biliary obstruction (MDBO) is not clear. This meta-analysis compared the efficacy of covered vs. uncovered SEMS for patients with MDBO after endoscopic insertion. METHODS: A systematic meta-analysis of all relevant articles listed in PubMed, the Cochrane Library, and Google Scholar databases was performed. Fixed effects or random effects models were used to investigate pooled effects with 95% confidence intervals (CIs). RESULTS: The meta-analysis included 2358 patients from 12 eligible studies. Time to recurrent biliary obstruction (RBO) was significantly longer for covered SEMS (mean difference, 45.51 days; 95% CI 11.79-79.24). Although there was no significant difference in the RBO rate, subgroup analysis in pancreatic cancer occupying more than 90% (PC) revealed that the RBO rates were significantly lower for covered SEMS (odds ratio [OR] 0.43, 95% CI 0.25-0.74). Stent migration, sludge formation, and overgrowth were significantly more common with a covered SEMS (OR 7.92, 95% CI 4.01-15.64; OR 3.25, 95% CI 1.89-5.59; OR 2.03, 95% CI 1.20-3.43, respectively). The rate of ingrowth was significantly lower for covered SEMS. There was no significant difference in total procedure-related adverse events between the two types of SEMS. CONCLUSIONS: A covered SEMS is superior to an uncovered SEMS with respect to prevention of RBO in patients with MDBO, particularly those caused by PC.