Metal versus plastic stents for drainage of malignant biliary obstruction before primary surgical resection.
OBJECTIVE
Preoperative biliary drainage (PBD) with stent placement has been commonly used for patients with malignant biliary obstruction. In PBD, the placement of fully covered self-expandable metal stents (FCSEMSs) may provide better patency duration and a lower incidence of cholangitis compared with plastic stents. We aimed to evaluate which type of stent showed better outcomes in PBD.


METHODS
In this multicenter, prospective randomized trial, we compared PBD with FCSEMSs versus plastic stents in 86 patients with malignant biliary obstruction between January 2012 and December 2014. Patients with obstructive jaundice were randomly assigned to undergo PBD either with plastic stents or FCSEMS placement.


RESULTS
Baseline characteristics were not significantly different between the 2 groups. Endoscopic stent placement was technically successful in all patients. Procedure-related adverse events were not significantly different between the 2 groups (plastic vs FCSEMS group; 16.3% vs 16.3%, P = 1.0). Reintervention was required in 16.3% of the plastic stent group and 14.0% of the FCSEMS group (P = .763). The interval to surgery after PBD (plastic vs FCSEMS group; 14.2 ± 8.3 vs 12.3 ± 6.9 days, P = .426) was not significantly different between groups. Surgery-related adverse events occurred in 43.6% of the plastic stent group and 40.0% of the FCSEMS group (P = .755).


CONCLUSIONS
In patients with resectable malignant biliary obstruction, the outcomes of PBD with plastic stents and FCSEMSs were similar. Considering the cost-effectiveness, PBD with plastic stents may be preferable to FCSEMS placement. (Clinical trial registration number: NCT01789502.).
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Tae Jun
TJ
Song
Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Jae Hoon
JH
Lee
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Sang Soo
SS
Lee
Department of Internal Medicine, Eulgi University College of Medicine, Daejeon, Korea.
Ji Woong
JW
Jang
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
Jung Wook
JW
Kim
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Tae Jin
TJ
Ok
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Dong Wook
DW
Oh
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Do Hyun
DH
Park
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Dong Wan
DW
Seo
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Sung Koo
SK
Lee
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Myung-Hwan
MH
Kim
Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Song Cheol
SC
Kim
Department of Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.
Chul Nam
CN
Kim
Department of Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Sung Cheol
SC
Yun
D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003138:Common Bile Duct Neoplasms / Q000150:complications / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010969:Plastics / Q000009:adverse effects; D011300:Preoperative Care; D011446:Prospective Studies; D011475:Prosthesis Failure / Q000209:etiology; D019233:Retreatment; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects; D016896:Treatment Outcome
D010969:Plastics