Efficacy and safety of plastic, covered and uncovered self-expandable metal stents in the treatment of malignant biliary obstructions (NEOSTENT)

Aims To date there is no agreement on which type of stent is the most suitable in patients with malignant biliary stricture. The present study aimed to analyze pros- and cons- of different stents available for biliary drainage.

Methods Data from 2752 procedures (2017-2021) across 23 endoscopic services were reviewed. Stenting was divided in plastic, uncovered SEMS (U-SEMS), partially-covered SEMS (PC-SEMS) and fully-covered SEMS (FC-SEMS).

Results Clinical success was similar between plastic and SEMS (p=0.633) but these latter significantly decreased the need for additional ERCP (odds ratio [OR]: 0.20; 95%CI: 0.15, 0.30; p=0.001). Comparing metallic stents, FC-SEMS significantly increased clinical success rate compared to U-SEMS (OR: 2.20; 95%CI: 1.63, 2.98; p=0.001) but did not prove better than PC-SEMS (OR: 1.58; 95%CI: 0.71, 3.52; p=0.256). FC-SEMS significantly decreased stent’ ingrowth (OR: 0.17; 95%CI: 0.09, 0.31; p=0.001) but increased migration rate (OR: 2.14; 95%CI: 0.62, 7.36; p=0.001) when compared to U-SEMS. PC-SEMS showed milder effect than FC-SEMS when compared to U-SEMS (p>0.05 in all cases). Considering post-procedural adverse events, U-SEMS showed the higher safety since both FC-SEMS (OR: 1.97; 95%CI: 1.04, 3.70; p=0.036) and PC-SEMS (OR: 1.59; 95%CI: 1.01, 2.52; p=0.047) significantly increased post-ERCP complications.

Conclusions When potential confounding were adequately handled and clinical success and adverse events were considered, each stent showed pros and cons. FC-SEMS showed a high clinical success at the price of a mild increase in post-ERCP complications.

Publikationsverlauf

Artikel online veröffentlicht:
14. April 2023