Document Detail

No benefit of covered vs uncovered self-expandable metal stents in patients with malignant distal biliary obstruction: a meta-analysis.
MedLine Citation:
PMID:  23103324     Owner:  NLM     Status:  MEDLINE    
BACKGROUND & AIMS: Self-expandable metal stents (SEMS) are used in patients with malignant distal biliary obstruction; trials that compared covered and uncovered SEMS reported different results because of heterogeneous designs and patient populations. These studies compared patency of uncovered SEMS and covered SEMS, along with rates of pancreatitis, cholecystitis, cholangitis, SEMS migration, bleeding, perforation, and recurrent biliary obstruction.
METHODS: We performed a meta-analysis to compare the effects of covered and uncovered SEMS in patients with malignant distal biliary obstruction. We identified randomized controlled trials by using a literature search from 1980 through March 2012. We evaluated data from 5 full articles and 4 abstracts, comprising 1061 patients, and assessed statistical heterogeneity and publication bias.
RESULTS: The weighted mean difference in the stent patency duration could only be calculated on the basis of 2 studies, but it was 67.9 days longer for covered SEMS than for uncovered SEMS (95% confidence interval [CI], 60.3-75.5). A summary analysis of data from 4 trials demonstrated no differences in patency of covered vs uncovered SEMS after 6 months (odds ratio [OR], 1.82; 95% CI, 0.62-5.25) or 12 months (OR, 1.25; 95% CI, 0.65-2.39). There were also no differences in the rates of pancreatitis, cholecystitis, perforation, bleeding, or cholangitis; length of hospital stay; or number of recurrent biliary obstructions. However, covered SEMS had a higher migration rate (OR, 7.13; 95% CI, 2.29-22.21). Patients with covered SEMS had a lower rate of tumor ingrowth (OR, 0.19; 95% CI, 0.07-0.55) but a higher rate of tumor overgrowth (OR, 1.88; 95% CI, 1.02-3.45). No summary calculations could be completed to confidently assess patient survival.
CONCLUSIONS: The use of covered SEMS, compared with uncovered SEMS, in patients with distal malignant biliary obstruction is of unclear benefit; covered SEMS have a higher rate of migration and do not appear to have longer patency.
Majid A Almadi; Alan N Barkun; Myriam Martel
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis     Date:  2012-10-23
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  11     ISSN:  1542-7714     ISO Abbreviation:  Clin. Gastroenterol. Hepatol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-18     Completed Date:  2013-05-23     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  27-37.e1     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.
Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, McGill University, Montreal, QC, Canada.
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MeSH Terms
Aged, 80 and over
Bile Duct Neoplasms / surgery*
Cholangitis / epidemiology
Cholecystitis / epidemiology
Cholestasis / surgery*
Hemorrhage / epidemiology
Middle Aged
Pancreatitis / epidemiology
Randomized Controlled Trials as Topic
Stents / adverse effects*
Treatment Outcome
Comment In:
Clin Gastroenterol Hepatol. 2013 Jun;11(6):748   [PMID:  23375999 ]
Clin Gastroenterol Hepatol. 2013 Jun;11(6):748-9   [PMID:  23511603 ]

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