Document Detail

Management of occluded metal stents in malignant biliary obstruction: similar outcomes with second metal stents compared to plastic stents.
MedLine Citation:
PMID:  22732833     Owner:  NLM     Status:  MEDLINE    
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.
Tilak Shah; Svetang Desai; Mahfuzul Haque; Hassan Dakik; Deborah Fisher
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review     Date:  2012-06-26
Journal Detail:
Title:  Digestive diseases and sciences     Volume:  57     ISSN:  1573-2568     ISO Abbreviation:  Dig. Dis. Sci.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-16     Completed Date:  2013-01-04     Revised Date:  2014-02-17    
Medline Journal Info:
Nlm Unique ID:  7902782     Medline TA:  Dig Dis Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2765-73     Citation Subset:  AIM; IM    
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MeSH Terms
Cholangiopancreatography, Endoscopic Retrograde
Cholestasis, Extrahepatic / etiology*,  radiography
Common Bile Duct Neoplasms / radiography,  therapy*
Jaundice, Obstructive / etiology*,  radiography
Outcome Assessment (Health Care)
Grant Support
Reg. No./Substance:
0/Metals; 0/Plastics

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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