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 language | English (US) |
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Pages (from-to) | 312-324 |
Number of pages | 13 |
Journal | Gastrointestinal endoscopy |
Volume | 78 |
Issue number | 2 |
DOIs | |
State | Published - 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