Metal versus plastic stents in the management of benign biliary strictures: systematic review and meta-analysis of randomized controlled trials

Abstract

Benign biliary strictures (BBS) are usually treated with endoscopic retrograde cholangiopancreatography (ERCP) with the placement of multiple plastic stents (MPS) or a covered self-expandable metal stent (CSEMS). In this meta-analysis, we compared the efficacy and safety of MPS and CSEMS in the management of BBS. We reviewed several databases from inception to 28 April 2021 to identify RCTs that compared MPS with CSEMS in the management of BBS. Our outcomes of interest were stricture resolution, stricture recurrence, adverse events, stent migration and mean number of ERCPs to achieve stricture resolution. Data were analyzed using a random-effects model. We included eight RCTs with 524 patients. We found no significant difference in the rate of stricture resolution (risk ratio, 1.02; 95% CI, 0.96–1.10), stricture recurrence (risk ratio, 1.68; 95% CI, 0.72–3.88) or adverse events (risk ratio, 1.17; 95% CI, 0.73–1.87) between groups. Mean number of ERCPs was significantly lower in the CSEMS group (SMD, −1.99; 95% CI, −3.35 to −0.64). The rate of stent migration was significantly higher in the CSEMS group. CSEMS are comparable in efficacy and safety to MPS in the management of BBS but require fewer ERCPs to achieve stricture resolution.

The utility of self-expanding metal stents in benign biliary strictures- a retrospective case series

“…In our study, the rate was 20.9%, and 25% of patients admitted with cholangitis secondary to stent migration. This is concordant with that shown in the literature of 16–40% rates of stent migration [ 8 , 14 , 28 , 30 , 33 ]. Many companies have attempted to mitigate this risk with the use of a variety of techniques including anti-migration flares [ 14 , 22 , 28 ].…”

“…SEMS demonstrated high rates of stricture resolution in our study, with 93% of patients achieving stricture resolution, with patients with chronic pancreatitis demonstrating lower rates. This is similar to that seen in other previous studies, including multiple systematic reviews and meta-analyses demonstrating good success of SEMS and similar rates in comparison to multiple plastic stents [ 1 , 9 , 21 , 24 , 28 – 30 ]. Rates of stricture resolution in patients with placement of multiple plastic stents has been shown to be similar.…”

“…Rates of recurrence were not evaluated in our study, but have been shown to be similar to those of plastic stents at 7–20% [ 24 , 28 – 30 ]. In our study, stent duration of 180–365 days appeared to be optimal for stricture resolution.…”