title: Plastic versus self-expanding metallic stents for malignant hilar biliary obstruction: a prospective multicenter observational cohort study.
abstract: 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.
authors: University of Minnesota, Minneapolis, MN, USA.
authors: David G
authors: DG
authors: Perdue
authors: Martin L
authors: ML
authors: Freeman
authors: James A
authors: JA
authors: DiSario
authors: Douglas B
authors: DB
authors: Nelson
authors: M Brian
authors: MB
authors: Fennerty
authors: John G
authors: JG
authors: Lee
authors: Carol S
authors: CS
authors: Overby
authors: Michael E
authors: ME
authors: Ryan
authors: Gary S
authors: GS
authors: Bochna
authors: Harry W
authors: HW
authors: Snady
authors: Joseph P
authors: JP
authors: Moore
mesh_terms: 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
chemical_list: D008670:Metals; D010969:Plastics; D001663:Bilirubin