A retrospective study assessing fully covered metal stents as first-line management for malignant biliary strictures.
OBJECTIVE
Fully covered self-expanding metal stents (FCSEMS) constitute the first type of metal stent that can easily be removed endoscopically and/or intraoperatively, which may be advantageous in the management of distal malignant biliary strictures (DMBS). To assess the efficacy of FCSEMS as first-line treatment for DMBS, we compared patency, survival and complication rates between FCSEMS, uncovered self-expanding metal stents (USEMS) and plastic stents (PS).


METHODS
This was a multicentre retrospective study of 315 consecutive patients with DMBS, who underwent endoscopic retrograde cholangiopancreatography and stenting (FCSEMS, USEMS or PS) at two hospitals between 1 January 2007 and 31 December 2013. Stent patency and patient survival were compared using the Kaplan-Meier method; complication rates were compared using Fisher's exact test; and Cox regression analysis was used to screen for confounding factors.


RESULTS
FCSEMS were associated with prolonged stent patency (median=145 days) compared with USEMS (median=110 days, P<0.003) and PS (median=34 days, P<0.001). Biliary sepsis rates were lower for FCSEMS compared with PS (4.7 vs. 17.8%, P=0.02), whereas pancreatitis rates were higher for FCSEMS compared with USEMS (7.8 vs. 1.0%, P=0.04), but not PS (2.6%, P=NS).


CONCLUSIONS
The use of FCSEMS as first-line management for DMBS is associated with longer patency and reduced complication rates compared with the use of PS. However, the higher rate of pancreatitis compared with USEMS requires further evaluation in a large randomized controlled trial.
Departments of aHepatology bGastroenterology, Cambridge University Hospitals NHS Foundation Trust cAnne McLaren Laboratory for Regenerative Medicine, Department of Surgery, Wellcome Trust-Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge dDepartment of Gastroenterology, West Hertfordshire Hospitals NHS Trust, Hertfordshire, UK.
Fotios
F
Sampaziotis
Joshua
J
Elias
William T H
WT
Gelson
Alexander E
AE
Gimson
William J H
WJ
Griffiths
Jeremy
J
Woodward
Mohamed
M
Shariff
Bruce
B
Macfarlane
Alistair
A
King
Gareth
G
Corbett
Anthony
A
Leahy
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000209:etiology; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000601:surgery; D002277:Carcinoma / Q000150:complications* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000150:complications* / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002780:Cholestasis, Intrahepatic / Q000209:etiology / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000601:surgery; D010195:Pancreatitis / Q000209:etiology; D010969:Plastics; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects; D015996:Survival Rate; D013997:Time Factors
D010969:Plastics