Partially Covered Metal Stents May Not Prolong Stent Patency Compared to Uncovered Stents in Unresectable Malignant Distal Biliary Obstruction

• Published in: Gut and liver Vol. 11; no. 3; pp. 440 - 446
• Main Authors: Kim, Jae Yun, Ko, Gyu Bong, Lee, Tae Hoon, Park, Sang-Heum, Lee, Yun Nah, Cho, Young Sin, Jung, Yunho, Chung, Il-Kwun, Choi, Hyun Jong, Cha, Sang-Woo, Moon, Jong Ho, Cho, Young Deok, Kim, Sun-Joo
• Format: Journal Article
• Language: English
• Published: Korea (South) Editorial Office of Gut and Liver 01.05.2017; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: Aged; Bile Duct Neoplasms - complications; biliary obstruction; Cholestasis - etiology; Cholestasis - surgery; covered; Female; Humans; Male; metal stent; Middle Aged; Original; Palliative Care - methods; patency; Prosthesis Failure; Retrospective Studies; Self Expandable Metallic Stents - adverse effects; Treatment Outcome; uncovered; 내과학; Patency; Biliary obstruction; Uncovered; Covered; Metal stent
• ISSN: 1976-2283; 2005-1212; 2005-1212
• DOI: 10.5009/gnl16245

Controversy still exists regarding the benefits of covered self-expandable metal stents (SEMSs) compared to uncovered SEMSs. We aimed to compare the patency and stent-related adverse events of partially covered SEMSs (PC-SEMSs) and uncovered SEMSs in unresectable malignant distal biliary obstruction. A total of 134 patients who received a PC-SEMS or uncovered SEMS for palliation of unresectable malignant distal biliary obstruction were reviewed retrospectively. The main outcome measures were stent patency, stent-related adverse events, and overall survival. The median stent patency was 118 days (range, 3 to 802 days) with PC-SEMSs and 105 days (range, 2 to 485 days) with uncovered SEMSs (p=0.718). The overall endoscopic revision rate due to stent dysfunction was 36.6% (26/71) with PC-SEMSs and 36.5% (23/63) with uncovered SEMSs (p=0.589). Tumor ingrowth was more frequent with uncovered SEMSs (4.2% vs 19.1%, p=0.013), but migration was more frequent with PC-SEMSs (11.2% vs 1.5%, p=0.04). The incidence of stent-related adverse events was 2.8% (2/71) with PC-SEMSs and 9.5% (6/63) with uncovered SEMSs (p=0.224). The median overall survival was 166 days with PC-SEMSs and 168 days with uncovered SEMSs (p=0.189). Compared to uncovered SEMSs, PC-SEMSs did not prolong stent patency in unresectable malignant distal biliary obstruction. Stent migration was more frequent with PC-SEMSs. However, tumor ingrowth was less frequent with PC-SEMSs compared to uncovered SEMSs.