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. 2012 Nov;57(11):2765-73.
doi: 10.1007/s10620-012-2272-7. Epub 2012 Jun 26.

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

Tilak Shah  1 , Svetang Desai, Mahfuzul Haque, Hassan Dakik, Deborah Fisher
Affiliations

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

Tilak Shah et al. Dig Dis Sci. 2012 Nov.

Abstract

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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Figures

Figure 1
Figure 1
Flow diagram of studies identified in the systematic review Search revealed 710 citations in Embase, and 475 citations in Web of Science. All of the 10 potential citations in Embase and 13 potential citations in Web of Science were excluded, since they were either duplicates or meeting abstracts.
Figure 2
Figure 2
Forest plot comparing proportion of patients with re-occluded plastic stents (PS) versus self expandable metal stents (SEMS)
Figure 3
Figure 3
Funnel plot of studies assessing proportion of patients with reoccluded plastic stents (PS) versus self expandable metal stents (SEMS)
Figure 4
Figure 4
Forest plot comparing patency in days of second self-expandable metal stents (SEMS) versus plastic stents (PS) placed in patients with initial SEMS occlusion
See this image and copyright information in PMC

References

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