Stent performance in palliative transhepatic treatment of malignant biliary obstruction: a randomized study comparing covered versus uncovered stents

Elkilany, Aboelyazid; Alwarraky, Mohamed S.; Geisel, Dominik; Maaly, Mohamed A; Denecke, Timm

doi:10.1177/0284185120911187

Cited by 3 publications

(9 citation statements)

References 30 publications

(59 reference statements)

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“…There were 36 studies included with 3502 total subjects analyzing 7 stents, FMS, PMS, UMS, PLS, IRS, ARS, and PXS (Figure 1) (Kaassis et al, 2003;Isayama et al, 2004;Soderlund and Linder, 2006;Krokidis et al, 2010;Kullman et al, 2010;Telford et al, 2010;Krokidis et al, 2011;Song et al, 2011;Chen et al, 2012;Sangchan et al, 2012;Zhu et al, 2012;Kitano et al, 2013;Moses et al, 2013;Mukai et al, 2013;Ung et al, 2013;Hu et al, 2014;Lee et al, 2014;Walter, 2014;Yang et al, 2015;Lee et al, 2016;Hasimu et al, 2017;Jang et al, 2017;Jiao et al, 2017;Bernon et al, 2018;Chen et al, 2018;Conio et al, 2018;Jang et al, 2018;Zhu et al, 2018;Hamada et al, 2019;Yuan et al, 2019;Cho et al, 2020;Dhondt et al, 2020;Elkilany et al, 2020;Sakai et al, 2021;Tamura et al, 2021;Wang et al, 2021). There were 7 pair comparisons can be made, such as ARS vs FMS, ARS vs PLS, ARS vs UMS, FMS vs PLS, FMS vs UMS, IRS vs UMS, PLS vs PMS, PLS vs UMS, PMS vs UMS, PXS vs UMS.…”

Section: Resultsmentioning

confidence: 99%

“…None of the studies showed the significant 30-day mortality risk compared to others. The highest risk of 30-day mortality were found in ARS, PLS, Linder, 2006; Krokidis et al, 2010;Kullman et al, 2010;Telford et al, 2010;Song et al, 2011;Chen et al, 2012;Sangchan et al, 2012;Zhu et al, 2012;Kitano et al, 2013;Moses et al, 2013;Mukai et al, 2013;Ung et al, 2013;Hu et al, 2014;Lee et al, 2014;Walter, 2014 33.19) in the rate of 30-day mortality than UMS (Figure 6) (Isayama et al, 2004;Sangchan et al, 2012;Zhu et al, 2012;Hu et al, 2014;Lee et al, 2016;Dhondt et al, 2020;Elkilany et al, 2020).…”

Section: -Day Mortalitymentioning

confidence: 93%

“…However, stents that had the highest clinical success were ARS, IRS, and UMS. ARS had a relative risk of 1.88 (95%CI 0.46-5.63) to achieve clinical success than UMS (Figure 5) (Soderlund and Linder, 2006;Sangchan et al, 2012;Hu et al, 2014;Lee et al, 2016;Zhu et al, 2018;Yuan et al, 2019;Dhondt et al, 2020;Elkilany et al, 2020).…”

Section: Clinical Successmentioning

confidence: 99%

“…The highest risk of stent occlusions were found in PLS, PXS, and UMS. PLS had a relative risk of 2.31 (95%CI 1.1-4.43) in developing stent occlusion than UMS (Figure 7) (Kaassis et al, 2003;Isayama et al, 2004;Soderlund and Linder, 2006;Krokidis et al, 2010;Kullman et al, 2010;Telford et al, 2010;Krokidis et al, 2011;Song et al, 2011;Chen et al, 2012;Zhu et al, 2012;Kitano et al, 2013;Mukai et al, 2013;Hu et Hasimu et al, 2017;Jang et al, 2017;Jiao et al, 2017;Chen et al, 2018;Conio et al, 2018;Jang et al, 2018;Zhu et al, 2018;Dhondt et al, 2020;Elkilany et al, 2020;Sakai et al, 2021;Tamura et al, 2021;Wang et al, 2021).…”

Section: Intraoperative Complications Stent Occlusionmentioning

confidence: 99%

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A Bayesian Network Meta-Analysis Comparing Biliary Stent Types’ Outcome and Complications in Unresectable Malignant Biliary Obstructions

Aryanti

Mahayasa

Mulyawan

2023

Asian Pac J Cancer Prev

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Objective: To conduct a network meta-analysis (NMA) in comparing biliary stents types' outcomes and complications in unresectable MBO. Methods: The study was conducted in accordance with the PRISMA and NMA extension . Comprehensive searches of the Cochrane Library, MEDLINE, and Scopus were done analyzing randomized controlled trials that included subjects with unresectable malignant biliary obstructions that underwent biliary stents placement from any approaches. The types of stents that included were full-covered metal (FMS), partially-covered metal (PMS), uncovered metal (UMS), plastic (PLS), Iodine-125 seeds strands (IRS), antireflux (ARS), and paclitaxel-coated (PXS) stents. The outcome parameters were clinical success, median patency duration, medial survival, and early 30-day mortality. The complications included were stent occlusion, stent migration, cholangitis, cholecystitis, pancreatitis, hemorrhage, and hemobilia. The NMA will be done based on Bayesian method, Markov Chain Monte Carlo algorithm, using BUGSnet package in R studio. Transivity was controlled by methods and consistency of the NMA will be fitted by deviance information criterion. Data analysis in NMA were presented in Sucra plot, league table, and forest plot. Result: Thirty-six RCTs were included with 3502 subjects. ARS had the best clinical success and longest median patency. However, it was associated with higher rate of complications. IRS had a good clinical success (RR 1.63; 95%CI 0.67-6.25), long median patency (MD 21.14;, and high significant survival rate (MD 69.89; 95%CI 22 to 117.57) compared to others stents. It was associated unsignificant complications of cholecystitis, hemobilia, and hemorrhage. Conclusion: Iodine-125 seeds strands had the promising good outcome and tolerated complications among others and should be considered as a standard stent to be used in unresectable malignant biliary obstructions.

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Section: Resultsmentioning

confidence: 99%

Section: -Day Mortalitymentioning

confidence: 93%

Section: Clinical Successmentioning

confidence: 99%

Section: Intraoperative Complications Stent Occlusionmentioning

confidence: 99%

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A Bayesian Network Meta-Analysis Comparing Biliary Stent Types’ Outcome and Complications in Unresectable Malignant Biliary Obstructions

Aryanti

Mahayasa

Mulyawan

2023

Asian Pac J Cancer Prev

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“…Three reports have asserted that the patency period of CSEMSs is superior to that of USEMSs[ 4 - 6 ]. However, others have found that the patency period is similar between CSEMSs and USEMSs[ 7 - 9 ]. Although CSEMS insertion has some disadvantages (such as cholecystitis, pancreatitis, and migration), the stent can be removed[ 7 , 10 - 13 ].…”

Section: Introductionmentioning

confidence: 99%

Biliary metal stents should be placed near the hilar duct in distal malignant biliary stricture patients

Sugimoto¹,

Takagi²,

Suzuki³

et al. 2022

WJG

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BACKGROUND Endoscopic biliary drainage using a self-expandable metallic stent (SEMS) has been widely performed to treat distal malignant biliary obstruction (DMBO). However, the optimal position of the stent remains unclear. AIM To determine the ideal position for SEMS placement. METHODS In total, 135 DMBO patients underwent SEMS (uncovered or covered) placement over a ten-year period. A total of 127 patients with biliary obstruction between the junction of the cystic duct and Vater’s papilla were enrolled. An SEMS was placed through the upper common bile duct 2 cm from the biliary hilar duct in 83 patients (Hilar group) or near the top of the biliary obstruction in 44 patients (Lower group). Technical and functional success, adverse events, and risk factors for SEMS dysfunction were evaluated. RESULTS The stent patency period was significantly longer in the Hilar group than in the Lower group ( P value < 0.01). In multivariate analysis, the only statistically significant risk factor for SEMS dysfunction was being in the Lower group (hazard ratio: 9.94, 95% confidence interval: 2.25–44.0, P < 0.01). CONCLUSION A longer patency period was achieved by positioning the SEMS near the biliary hilar duct.

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TOKYO criteria 2024 for the assessment of clinical outcomes of endoscopic biliary drainage

Isayama,

Hamada,

Fujisawa

et al. 2024

Digestive Endoscopy

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The consensus‐based TOKYO criteria were proposed as a standardized reporting system for endoscopic transpapillary biliary drainage. The primary objective was to address issues arising from the inconsistent reporting of stent outcomes across studies, which has complicated the comparability and interpretation of study results. However, the original TOKYO criteria were not readily applicable to recent modalities of endoscopic biliary drainage such as biliary drainage based on endoscopic ultrasound or device‐assisted endoscopy. There are increasing opportunities for managing hilar biliary obstruction and benign biliary strictures through endoscopic drainage. Biliary ablation has been introduced to manage benign and malignant biliary strictures. In addition, the prolonged survival times of cancer patients have increased the importance of evaluating overall outcomes during the period requiring endoscopic biliary drainage rather than solely focusing on the patency of the initial stent. Recognizing these unmet needs, a committee has been established within the Japan Gastroenterological Endoscopy Society to revise the TOKYO criteria for current clinical practice. The revised criteria propose not only common reporting items for endoscopic biliary drainage overall, but also items specific to various conditions and interventions. The term “stent‐demanding time” has been defined to encompass the entire duration of endoscopic biliary drainage, during which the overall stent‐related outcomes are evaluated. The revised TOKYO criteria 2024 are expected to facilitate the design and reporting of clinical studies, providing a goal‐oriented approach to the evaluation of endoscopic biliary drainage.

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Stent performance in palliative transhepatic treatment of malignant biliary obstruction: a randomized study comparing covered versus uncovered stents

Cited by 3 publications

References 30 publications

A Bayesian Network Meta-Analysis Comparing Biliary Stent Types’ Outcome and Complications in Unresectable Malignant Biliary Obstructions

A Bayesian Network Meta-Analysis Comparing Biliary Stent Types’ Outcome and Complications in Unresectable Malignant Biliary Obstructions

Biliary metal stents should be placed near the hilar duct in distal malignant biliary stricture patients

TOKYO criteria 2024 for the assessment of clinical outcomes of endoscopic biliary drainage

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