Comparison of the utility of covered metal stents versus uncovered metal stents in the management of malignant biliary strictures in 749 patients

Jeffrey H. Lee, Somashekar G. Krishna, Amanpal Singh, Harshad S. Ladha, Rebecca S. Slack, Srinivas Ramireddy, Gottumukkala S. Raju, Marta Davila, William A. Ross

Research output: Contribution to journalArticlepeer-review

79 Scopus citations

Abstract

Background: Self-expandable metal stents (SEMSs) are used to relieve malignant biliary obstruction. Objective: To compare outcomes between covered self-expandable metal stents (CSEMSs) and uncovered self-expandable metal stents (USEMSs) in malignant biliary obstruction. Design: Retrospective cohort study. Setting: Tertiary cancer center. Patients: Patients with malignant biliary obstruction. Interventions: Placement of CSEMS or USEMS. Main outcome measurements: Time to recurrent biliary obstruction (TRO), overall survival (OS), and adverse events. Results: From January 2000 to June 2011, 749 patients received SEMSs: 171 CSEMSs and 578 USEMSs. At 1 year, there was no significant difference in the percentage of patients with recurrent obstruction (CSEMSs, 35% vs USEMSs, 38%) and survival (CSEMSs, 45% vs USEMSs, 49%). There was no significant difference in the median OS (CSEMSs, 10.4 months vs USEMSs, 11.8 months; P =.84) and the median TRO (CSEMSs, 15.4 months vs USEMSs, 26.3 months; P =.61). The adverse event rate was 27.5% for the CSEMS group and 27.7% for the USEMS group. Although tumor ingrowth with recurrent obstruction was more common in the USEMS group (76% vs 9%, P <.001), stent migration (36% vs 2%, P <.001) and acute pancreatitis (6% vs 1%, P <.001) were more common in the CSEMS group. Limitations: Retrospective study. Conclusions: There was no significant difference in the patency rate or overall survival between CSEMSs and USEMSs for malignant distal biliary strictures. The CSEMS group had a significantly higher rate of migration and pancreatitis than the USEMS group. No significant SEMS-related adverse events were observed in patients undergoing neoadjuvant chemoradiation or surgical resection.

Original languageEnglish (US)
Pages (from-to)312-324
Number of pages13
JournalGastrointestinal endoscopy
Volume78
Issue number2
DOIs
StatePublished - Aug 2013

Keywords

  • CSEMS
  • OS
  • ROFS
  • SE
  • SEMS
  • TRO
  • USEMS
  • covered self-expandable metal stent
  • overall survival
  • recurrent obstruction-free survival
  • self-expandable metal stent
  • standard error
  • time to recurrent biliary obstruction
  • uncovered self-expandable metal stent

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

MD Anderson CCSG core facilities

  • Biostatistics Resource Group

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