title: Metal versus plastic stents for unresectable gallbladder cancer with hilar duct obstruction.
abstract: OBJECTIVE
  Metal stents usually have a longer stent patency than plastic stents for malignant biliary obstruction. However, stent patency and patient survival may differ depending on the causative disease and stent type. There are no data regarding the selection of stents for unresectable gallbladder cancer (GC) with hilar duct obstruction. The aim of the present study was to evaluate the efficacy of metal versus plastic stents for unresectable GC with hilar duct obstruction.
  
  
  METHODS
  Fifty-nine unresectable GC patients with jaundice were divided into metal stent group (MSG) and plastic stent group (PSG) depending on stent deployment. Clinical outcomes and approximate costs were assessed retrospectively.
  
  
  RESULTS
  No significant difference was found between MSG (n = 28) and PSG (n = 31) for clinical success, early adverse events and later cholangitis. Median patency and survival were 119 and 112 days in MSG versus 93 and 118 days in PSG, respectively (P > 0.05). However, the overall cost was higher in MSG than in PSG (P = 0.00). Cox proportional hazards model analysis showed that the lower Bismuth type was associated with a longer stent patency (P = 0.046), whereas older age (P = 0.041) and lower TNM stage (P = 0.002) were associated with longer survival.
  
  
  CONCLUSIONS
  Although metal and plastic stents have similar clinical efficacy, it seems reasonable to choose plastic stents as the treatment of choice for unresectable GC when cost-effectiveness is taken into account.
authors.affiliation: Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Dao-Jian
authors.initials: DJ
authors.lastname: Gao
authors.affiliation: Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Hu
authors.affiliation: Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Ye
authors.affiliation: Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Tian-Tian
authors.initials: TT
authors.lastname: Wang
authors.affiliation: Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods*; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents
keywords: endoscopic retrograde cholangiopancreatography (ERCP); gallbladder cancer; malignant biliary obstruction; plastic stent; self-expandable metal stent