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Partially Covered Versus Uncovered Self-Expandable Metal Stents: Coating Nor Diameter Affect Clinical Outcomes

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Abstract

Introduction

Jaundice is a common initial presentation of malignant biliary stricture. In patients with life expectancies that are greater than 3 months, self-expanding metal stents (SEMS) offer a larger diameter stent with longer patency and fewer complications compared to plastic stents. There have been conflicting results in the published literature as to efficacy and safety between the various SEMS types and diameters. We compared stent coating (PCSEMS vs USEMS) and diameter on clinical outcomes regarding management of malignant biliary obstruction.

Methods

A retrospective cohort study was conducted using a database of consecutive patients who underwent an ERCP with biliary SEMS placement (only 8 and 10 mm) between 2009 and 2017.

Results

In total, 278 patients who had SEMS at ERCP for malignant biliary obstruction were included (213 PCSEMS vs 65 USEMS). The groups were demographically evenly matched. Clinical success rates and patency duration were not statistically significant between PCSEMS and USEMS (98.1% vs 95.5%, P = 0.36, and 302.5 vs 225.5 days, P = 0.72, respectively). Adverse event rates were similar between both PCSEMS and USEMS with regard to overall adverse events. Stent diameter did not have an impact on overall clinical success (98.9% vs 95.3%, P = 0.11) or patency duration (239 days vs 336 days, P = 0.51).

Conclusions

Our comparison of PCSEMS versus USEMS and 8 mm versus 10 mm showed no difference in clinical efficacy or adverse events between the two SEMS coatings and diameter, illustrating that coating and size do not matter in regard to stent choice, despite prior suggestive data.

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Authors and Affiliations

  1. Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine, 5700 S. Maryland Avenue, MC 8043, Chicago, IL, 60637, USA

    S. P. Shamah, C. G. Chapman, H. Haider, C. Liao, I. Waxman & U. D. Siddiqui

Authors
  1. S. P. Shamah
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  2. C. G. Chapman
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  3. H. Haider
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  4. C. Liao
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  5. I. Waxman
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  6. U. D. Siddiqui
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Contributions

SPS conceived and designed the study; analyzed and interpreted the data; and drafted the article. CGC critically revised the article for important intellectual content and finally approved the article. HH and CL analyzed and interpreted the data. IW finally approved the article. UDS conceived and designed the study; analyzed and interpreted the data; drafted the article; critically revised the article for important intellectual content; and finally approved the article.

Corresponding author

Correspondence to S. P. Shamah.

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Conflict of interest

SP Shamah, H Haider and C Liao have no disclosures. CG Chapman is a consultant for Apollo EndoSurgery and Neurotronic. I Waxman is a consultant for Cook Medical, Boston Scientific, Neurotronic, Olympus, and Medtronic. UD Siddiqui is a consultant for Olympus, Boston Scientific, and Medtronic

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Shamah, S.P., Chapman, C.G., Haider, H. et al. Partially Covered Versus Uncovered Self-Expandable Metal Stents: Coating Nor Diameter Affect Clinical Outcomes. Dig Dis Sci 64, 2631–2637 (2019). https://doi.org/10.1007/s10620-019-05643-1

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  • DOI: https://doi.org/10.1007/s10620-019-05643-1

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