Plastic versus self-expanding metallic stents for malignant hilar biliary obstruction: a prospective multicenter observational cohort study.
BACKGROUND
There are few comparative data as to whether plastic or self-expanding metallic stents are preferable for palliating malignant hilar biliary obstruction.


METHODS
Thirty-day outcomes of consecutive endoscopic retrograde cholangiopancreatographies performed for malignant hilar obstruction at 6 private and 5 university centers were assessed prospectively.


RESULTS
Patients receiving plastic (N=28) and metallic stents (N=34) were similar except that metallic stent recipients more often had: Bismuth III or IV tumors (16/34 vs. 5/28 P=0.043), higher Charlson comorbidity scores (P=0.003), metastatic disease (P=0.006), and management at academic centers (P=0.018). The groups had similar rates of bilateral stent placement (4/28 vs. 5/34), and similar frequency of opacified but undrained segmental ducts (7/28 vs. 5/34). Adverse outcomes including cholangitis, stent occlusion, migration, perforation, and/or the need for unplanned endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography occurred in 11/28 (39.3%) patients with plastic versus 4/34 (11.8%) with metal stents (P=0.017). By logistic regression, factors associated with adverse outcomes included plastic stent placement (odds ratio 6.32; 95% confidence interval 1.23, 32.56) and serum bilirubin (1.11/mg/dL above normal: 1.01, 1.22) but not center type or Bismuth class.


CONCLUSIONS
Metallic stent performance was superior to plastic for hilar tumor palliation with respect to short-term outcomes, independent of disease severity, Bismuth class, or drainage quality.
Perdue
David G
DG
University of Minnesota, Minneapolis, MN, USA.
Freeman
Martin L
ML
DiSario
James A
JA
Nelson
Douglas B
DB
Fennerty
M Brian
MB
Lee
John G
JG
Overby
Carol S
CS
Ryan
Michael E
ME
Bochna
Gary S
GS
Snady
Harry W
HW
Moore
Joseph P
JP
D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000473:pathology; D001652:Bile Ducts / Q000473:pathology / Q000601:surgery*; D001663:Bilirubin / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D015331:Cohort Studies; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010166:Palliative Care / Q000379:methods; D010969:Plastics; D011446:Prospective Studies; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects
D008670:Metals; D010969:Plastics; D001663:Bilirubin