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Management of Occluded Metal Stents in Malignant Biliary Obstruction: Similar Outcomes with Second Metal Stents Compared to Plastic Stents

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Abstract

Background

Covered or uncovered self expandable metallic stents (SEMS) placed in patients with malignant biliary obstruction can occlude in 19–40 %, but optimal management is unclear.

Aim

We sought to summarize current evidence regarding management of occluded SEMS in patients with malignant biliary obstruction.

Methods

Two investigators independently searched Pubmed, Embase, and Web of Science using pre-defined search criteria, and reviewed bibliographies of included studies. Data were independently abstracted by two investigators, and analyzed using RevMan. We compared strategies of second SEMS versus plastic stents with respect to the following outcomes: rate of second stent re-occlusion, duration of second stent patency, and survival.

Results

Ten retrospective studies met inclusion criteria for the systematic review. Management options described were placement of an uncovered SEMS (n = 125), covered SEMS (n = 106), plastic stent (n = 135), percutaneous biliary drain (n = 7), mechanical cleaning (n = 18), or microwave coagulation (n = 7). Relative risk of re-occlusion was not significantly different in patients with second SEMS compared to plastic stents (RR 1.24, 95 % CI 0.92, 1.67, I2 = 0, p 0.16). Duration of second stent patency was not significantly different between patients who received second SEMS versus plastic stents (weighted mean difference 0.46, 95 % CI −0.30, 1.23, I2 = 83 %). Survival was not significantly different among patients who received plastic stents versus SEMS (weighted mean difference −1.13, 95 % CI −2.33, 0.07, I2 86 %, p = 0.07).

Conclusions

Among patients with malignant biliary obstruction and occluded SEMS, available evidence suggests a strategy of placing a plastic stent may be as effective as second SEMS. Limitations of these findings were that all studies were retrospective and heterogeneity between studies was detected for two of the outcomes.

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Acknowledgments

Dr. Shah was supported by an NIH T32 (5T32DK007568—21). Dr. Fisher was supported in part by an ASGE Senior Investigator Mentoring Award.

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Authors and Affiliations

  1. Division of Gastroenterology, Duke University Medical Center, Box 3913, Durham, NC, 27710, USA

    Tilak Shah, Svetang Desai, Mahfuzul Haque, Hassan Dakik & Deborah Fisher

  2. Durham VA Medical Center, Durham, NC, USA

    Tilak Shah, Svetang Desai, Mahfuzul Haque, Hassan Dakik & Deborah Fisher

Authors
  1. Tilak Shah
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  2. Svetang Desai
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  3. Mahfuzul Haque
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  4. Hassan Dakik
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  5. Deborah Fisher
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Correspondence to Tilak Shah.

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Shah, T., Desai, S., Haque, M. et al. Management of Occluded Metal Stents in Malignant Biliary Obstruction: Similar Outcomes with Second Metal Stents Compared to Plastic Stents. Dig Dis Sci 57, 2765–2773 (2012). https://doi.org/10.1007/s10620-012-2272-7

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  • DOI: https://doi.org/10.1007/s10620-012-2272-7

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