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Review
. 2023 Jan 23;12(3):898.
doi: 10.3390/jcm12030898.

Suprapapillary Biliary Stents Have Longer Patency Times than Transpapillary Stents-A Systematic Review and Meta-Analysis

Norbert Kovács  1   2   3 , Dániel Pécsi  2   4 , Zoltán Sipos  2 , Nelli Farkas  5 , Mária Földi  1   2   6 , Péter Hegyi  2   3   7   8 , Judit Bajor  4 , Bálint Erőss  2   3   7 , Katalin Márta  2   3   7 , Alexandra Mikó  2   9 , Zoltán Rakonczay Jr  10 , Patrícia Sarlós  4 , Szabolcs Ábrahám  11 , Áron Vincze  4
Affiliations
Review

Suprapapillary Biliary Stents Have Longer Patency Times than Transpapillary Stents-A Systematic Review and Meta-Analysis

Norbert Kovács et al. J Clin Med. .

Abstract

Background and study aims: Endoscopic biliary stent placement is a minimally invasive intervention for patients with biliary strictures. Stent patency and function time are crucial factors. Suprapapillary versus transpapillary stent positioning may contribute to stent function time, so a meta-analysis was performed in this comparison.

Methods: A comprehensive literature search was conducted in the CENTRAL, Embase, and MEDLINE databases to find data on suprapapillary stent placement compared to the transpapillary method via endoscopic retrograde cholangiopancreatography in cases of biliary stenosis of any etiology and any stent type until December 2020. We carried out a meta-analysis focusing on the following outcomes: stent patency, stent migration, rate of cholangitis and pancreatitis, and other reported complications.

Results: Three prospective and ten retrospective studies involving 1028 patients were included. Suprapapillary stent placement appeared to be superior to transpapillary stent positioning in patency (weighted mean difference = 50.23 days, 95% CI: 8.56, 91.98; p = 0.0.018). In a subgroup analysis of malignant indications, suprapapillary positioning showed a lower rate of cholangitis (OR: 0.34, 95% CI: 0.13, 0.93; p = 0.036). Another subgroup analysis investigating metal stents in a suprapapillary position resulted in a lower rate of pancreatitis (OR: 0.16, 95% CI: 0.03, 0.95; p = 0.043) compared to transpapillary stent placement. There was no difference in stent migration rates between the two groups (OR: 0.67, 95% CI: 0.17, 2.72; p = 0.577).

Conclusions: Based on our results, suprapapillary biliary stenting has longer stent patency. Moreover, the stent migration rate did not differ between the suprapapillary and transpapillary groups.

Keywords: ERCP; endoscopy; inside; intraductal; stent.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram.
Figure 2
Figure 2
Forest plot comparing the stent patency time between suprapapillary and transpapillary stents. Unit of measurement: days. WMD: weighted mean difference; p: p-value; CI: confidence interval; I-squared: I2. [3,8,12,22,23,24,25,26,27,28,31].
Figure 3
Figure 3
Forest plot comparing stent migration rate between suprapapillary and transpapillary stents. OR: odds ratio, p: p-value; CI: confidence interval; I-squared: I2. [3,8,12,25,26,28,29].
Figure 4
Figure 4
Forest plot comparing cholangitis rate between suprapapillary and transpapillary stents. OR: odds ratio, p: p-value; CI: confidence interval; I-squared: I2. [12,22,23,26,27,28].
Figure 5
Figure 5
Forest plot comparing pancreatitis rate between suprapapillary and transpapillary stents. OR: odds ratio, p: P-value; CI: confidence interval; I-squared: I2. [23,25,26,27,28].
See this image and copyright information in PMC

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