Fully covered versus partially covered self-expandable metal stents for palliation of distal malignant biliary obstruction: a systematic review and meta-analysis

Same-session endoscopic diagnosis and symptom palliation in pancreato-biliary malignancies: Clinical impact of rapid on-site evaluation (ROSE)

“…Retrograde biliary stenting is usually performed through SEMS, with plastic stents restricted to resectable hilar malignancies or inadequate sampling. For distal malignant stenoses, a partially-covered SEMS (PC-SEMS) is usually preferred 15 , whereas uncovered SEMS are usually preferred in unresectable hilar malignancies.…”

“…However, plastic stenting has demonstrated a significantly higher rate of jaundice recurrence, even in the neoadjuvant setting, and this might result in unplanned readmission or chemotherapy interruptions in these patients [12]. Although FC-SEMS might be a good compromise in distal stenoses, PC-SEMS seems associated with longer patency and might be preferrable in case of confirmed malignancies [15]. Moreover, FC-SEMS are not recommended for hilar strictures, due to the risk of obstructing side biliary branches [34]; therefore, an unconfirmed malignancy would preclude the placement of better-performing UC-SEMS.…”

Endoscopic management of malignant biliary obstructions

“…Regarding C-SEMS, a meta-analysis by Vanella found that time to recurrent biliary obstruction was shorter for FC-SEMS (238, 95%CI 191-286 days; I 2 =63.1%) vs. PC-SEMS (369, 95%CI 290-449 days; I 2 =71.9%), with considerable heterogeneity. The 2 types of covered SEMS showed no difference in adverse event rates, with small differences in the rate of ingrowth (FC-SEMS 0.5% vs. PC-SEMS 2.9%) and migration (FC-SEMS 9.8% vs. PC-SEMS 4.3%) [ 28 ]. Specific stent designs to overcome the main limitations have been investigated, including antireflux covered SEMS, anti-migration systems as well as drug-eluting metal stents (paclitaxel-incorporated stents), with different results [ 10 ].…”