title: Covered versus uncovered self-expandable metal stents for malignant biliary strictures: A meta-analysis and systematic review.
abstract: Self-expandable metal stents (SEMS) are used for palliating inoperable malignant biliary strictures. It is unclear if covered metal stents are superior to uncovered metal stents in these patients. We compared clinical outcomes in patients with covered and uncovered stents. Studies using covered and uncovered metallic stents for palliation in patients with malignant biliary stricture were reviewed. Articles were searched in MEDLINE, PubMed, and Ovid journals. Fixed and random effects models were used to calculate the pooled proportions. Initial search identified 1436 reference articles, of which 132 were selected and reviewed. Thirteen studies (n = 2239) for covered and uncovered metallic stents which met the inclusion criteria were included in this analysis. Odds ratio for stent occlusion rates in covered vs. uncovered stents was 0.79 (95 % CI = 0.65 to 0.96). Survival benefit in patients with covered vs. uncovered stents showed the odds ratio to be 1.29 (95 % CI = 0.95 to 1.74). Pooled odds ratio for migration of covered vs. uncovered stents was 9.9 (95 % CI = 4.5 to 22.3). Covered stents seemed to have significantly lesser occlusion rates, increased odds of migration, and increased odds of pancreatitis compared to uncovered stents. There was no statistically significant difference in the survival benefit, overall adverse event rate, and patency period of covered vs. uncovered metal stents in patients with malignant biliary strictures.
authors: Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA. harsha1778@yahoo.co.in.
authors: Harsha
authors: H
authors: Moole
authors: Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, USA.
authors: Matthew L
authors: ML
authors: Bechtold
authors: Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
authors: Micheal
authors: M
authors: Cashman
authors: Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
authors: Fritz H
authors: FH
authors: Volmar
authors: Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
authors: Sonu
authors: S
authors: Dhillon
authors: Interventional Endoscopy Services, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: David
authors: D
authors: Forcione
authors: Department of Medicine, Division of Pulmonary Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
authors: Deepak
authors: D
authors: Taneja
authors: Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
authors: Srinivas R
authors: SR
authors: Puli
mesh_terms: D001661:Biliary Tract Neoplasms / Q000150:complications; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D016206:Databases, Bibliographic; D005706:Gallbladder Neoplasms / Q000150:complications; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000628:therapy*; D008113:Liver Neoplasms / Q000150:complications; D008670:Metals; D016017:Odds Ratio; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications; D015607:Stents / Q000009:adverse effects / Q000145:classification; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: Bile duct cancer; Obstructive jaundice; Palliation