Review

Digestive Diseases and Sciences

, Volume 57, Issue 11, pp 2765-2773

First online:

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

  • Tilak ShahAffiliated withDivision of Gastroenterology, Duke University Medical CenterDurham VA Medical Center Email author 
  • , Svetang DesaiAffiliated withDivision of Gastroenterology, Duke University Medical CenterDurham VA Medical Center
  • , Mahfuzul HaqueAffiliated withDivision of Gastroenterology, Duke University Medical CenterDurham VA Medical Center
  • , Hassan DakikAffiliated withDivision of Gastroenterology, Duke University Medical CenterDurham VA Medical Center
  • , Deborah FisherAffiliated withDivision of Gastroenterology, Duke University Medical CenterDurham VA Medical Center

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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.

Keywords

Endoscopic retrograde cholangiopancreatography Stents Obstructive jaundice Extrahepatic cholestasis Neoplasms