Background: A variety of stent designs has been studied for endoscopic stenting of the bile duct in patients with malignant biliary obstruction. Although metal stents are associated with longer patency, their costs are significantly higher than plastic stents.
Aims: To compare clinical outcome and cost-effectiveness of endoscopic metal and plastic stents for malignant biliary obstruction by a systematic review and meta-analysis of all randomized controlled trials in this area.
Methods: We conducted searches to identify all randomized controlled trials in any language from 1966 to 2006 using electronic databases and hand-searching of conference abstracts. Meta-analysis was performed with RevMan software [Review Manager (RevMan) version 4.2 for Windows. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2003].
Results: Seven randomized controlled trials were identified that met the inclusion criteria, and 724 participants were randomized to either metal or plastic endoscopic stents. No significant difference between the two stent types in terms of technical success, therapeutic success, 30-day mortality or complications was observed. Metal stents were associated with a significantly less relative risk (RR) of stent occlusion at 4 months than plastic stents [RR, 0.44; 95% confidence interval (CI) 0.3, 0.63; P<0.01]. The overall risk of recurrent biliary obstruction was also significantly lower in patients treated with metal stents (RR, 0.52; 95% confidence interval 0.39, 0.69; P<0.01). The median incremental cost-effectiveness ratio of metal stents was $1820 per endoscopic retrograde cholangiopancreatography prevented.
Conclusion: Endoscopic metal stents for malignant biliary obstruction are associated with significantly higher patency rates than plastic stents as early as 4 months after insertion. Metal stents will be cost-effective if the unit cost of additional endoscopic retrograde cholangiopancreatographies per patient exceeds $1820.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/MEG.0b013e3282f16206 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Endoscopic Management of Concomitant Malignant Biliary and Gastric Outlet Obstruction.
Cureus
December 2024
Surgery, Memorial University of Newfoundland, St. John's, CAN.
Concurrent malignant biliary and gastric outlet obstruction requires urgent palliative intervention to improve patient quality of life and permit systemic therapy. Traditional management has been surgical gastrojejunostomy and hepaticojejunostomy, two morbid procedures. Comparatively, endoscopic stenting can relieve both sites of obstruction with less complications and quicker recovery.
View Article and Find Full Text PDFBleeding From Unintentional Portal Vein Stenting During Endoscopic Retrograde Cholangiopancreatography Managed With Portal Vein Stent Graft Placement-A Case Report With a Detailed Review of the Literature.
J Clin Exp Hepatol
November 2024
Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India.
Suspicion of vascular injury during endoscopic retrograde cholangiopancreatography (ERCP) should be raised in the event of intraprocedural bleeding, persistent hyperbilirubinemia, and sepsis despite biliary stenting. Most inadvertent portal vein (PV) cannulations during ERCP are innocuous, and mere withdrawal of guidewire and catheter suffices. However, unintentional PV stenting, particularly with larger metallic stents, increases the likelihood of significant bleeding.
View Article and Find Full Text PDFA Bleed From the Distal Anastomosis Site of a Bypass Graft From the Left Common Iliac Artery to the Celiac Trunk Treated With a Surgeon-Modified Fenestrated Endograft.
J Endovasc Ther
January 2025
Vascular Unit, Department of Surgery, Mater Dei Hospital, Msida, Malta.
Purpose: The use of surgeon-modified fenestrated endograft to treat a bleeding complication in the common iliac artery.
Technique: An Endurant limb graft was modified on back table in theater after planning the fenestration using a semi-automated centerline. The Endurant stent was planned to land flush at the aortic bifurcation.
Degraded products generated by iron stent inhibit the vascular smooth muscle cell proliferation by downregulating AP-1.
J Mater Sci Mater Med
January 2025
Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, PR China.
In-stent restenosis (ISR) following interventional therapy is a fatal clinical complication. Current evidence indicates that neointimal hyperplasia driven by uncontrolled proliferation of vascular smooth muscle cells (VSMC) is a major cause of restenosis. This implies that inhibiting VSMC proliferation may be an attractive approach for preventing in-stent restenosis.
View Article and Find Full Text PDFDesign, Safety and Efficacy Evaluation of Gemcitabine-eluting Nanoyarn-integrated Heparinized Self Expanding Metallic Stents for Long-Term Management of Malignant Biliary Obstruction.
Acta Biomater
January 2025
Amrita School of Nanosciences & Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India. Electronic address:
Malignant biliary obstruction presents a significant therapeutic challenge and has serious consequences including cholangitis and death. Clinically, biliary stenting using self-expanding metallic- stent(SEMS) relieves this obstruction. However, stent occlusion occurs with time due to tumor/epithelial in-growth and bacterial colonization.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!