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Comparative Study
. 2021 Jul;161(1):185-195.
doi: 10.1053/j.gastro.2021.03.015. Epub 2021 Mar 17.

Fully Covered Self-Expanding Metal Stent vs Multiple Plastic Stents to Treat Benign Biliary Strictures Secondary to Chronic Pancreatitis: A Multicenter Randomized Trial

Mohan Ramchandani  1 , Sundeep Lakhtakia  1 , Guido Costamagna  2 , Andrea Tringali  2 , Andreas Püspöek  3 , Barbara Tribl  4 , Werner Dolak  4 , Jacques Devière  5 , Marianna Arvanitakis  5 , Schalk van der Merwe  6 , Wim Laleman  6 , Thierry Ponchon  7 , Vincent Lepilliez  7 , Armando Gabbrielli  8 , Laura Bernardoni  8 , Marco J Bruno  9 , Jan-Werner Poley  9 , Urban Arnelo  10 , James Lau  11 , André Roy  12 , Michael Bourke  13 , Arthur Kaffes  14 , Horst Neuhaus  15 , Joyce Peetermans  16 , Matthew Rousseau  16 , D Nageshwar Reddy  17
Affiliations
Comparative Study

Fully Covered Self-Expanding Metal Stent vs Multiple Plastic Stents to Treat Benign Biliary Strictures Secondary to Chronic Pancreatitis: A Multicenter Randomized Trial

Mohan Ramchandani et al. Gastroenterology. 2021 Jul.

Abstract

Background & aims: Benign biliary strictures (BBS) are complications of chronic pancreatitis (CP). Endotherapy using multiple plastic stents (MPS) or a fully covered self-expanding metal stent (FCSEMS) are acceptable treatment options for biliary obstructive symptoms in these patients.

Methods: Patients with symptomatic CP-associated BBS enrolled in a multicenter randomized noninferiority trial comparing 12-month treatment with MPS vs FCSEMS. Primary outcome was stricture resolution status at 24 months, defined as absence of restenting and 24-month serum alkaline phosphatase not exceeding twice the level at stenting completion. Secondary outcomes included crossover rate, numbers of endoscopic retrograde cholangiopancreatography (ERCPs) and stents, and stent- or procedure-related serious adverse events.

Results: Eighty-four patients were randomized to MPS and 80 to FCSEMS. Baseline technical success was 97.6% for MPS and 98.6% for FCSEMS. Eleven patients crossed over from MPS to FCSEMS, and 10 from FCSEMS to MPS. For MPS vs FCSEMS, respectively, stricture resolution status at 24 months was 77.1% (54/70) vs 75.8% (47/62) (P = .008 for noninferiority intention-to-treat analysis), mean number of ERCPs was 3.9 ± 1.3 vs 2.6 ± 1.3 (P < .001, intention-to-treat), and mean number of stents placed was 7.0 ± 4.4 vs 1.3 ± .6 (P < .001, as-treated). Serious adverse events occurred in 16 (19.0%) MPS and 19 (23.8%) FCSEMS patients (P = .568), including cholangitis/fever/jaundice (9 vs 7 patients respectively), abdominal pain (5 vs 5), cholecystitis (1 vs 3) and post-ERCP pancreatitis (0 vs 2). No stent- or procedure-related deaths occurred.

Conclusions: Endotherapy of CP-associated BBS has similar efficacy and safety for 12-month treatment using MPS compared with a single FCSEMS, with FCSEMS requiring fewer ERCPs over 2 years. (ClinicalTrials.gov, Number: NCT01543256.).

Keywords: Benign Biliary Strictures; Biliary Stenting; Chronic Pancreatitis; Plastic Stents; Randomized Trial; Self-Expandable Metallic Stents.

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