Original articleSystematic reviews and meta-analysesNo Benefit of Covered vs Uncovered Self-Expandable Metal Stents in Patients With Malignant Distal Biliary Obstruction: A Meta-analysis
Section snippets
Search Strategy
A computerized medical literature search was performed by using OVID MEDLINE, EMBASE, Cochrane Library, and the ISI Web of Knowledge from 1980 to March 2012. All abstracts from Digestive Disease Week, Canadian Digestive Diseases Week, and United European Gastroenterology Week were also searched, as were clinical trials databases (http://www.clinicaltrials.gov). A highly sensitive search strategy was used to identify reports of randomized controlled trials comparing patency duration and rates of
Study Selection
From a total of 649 citations identified through the systematic review, 501 articles were excluded because they did not address the topic under study, 36 articles were reviews, 27 studies compared surgery with biliary stenting, 23 addressed preoperative stenting, 19 were related to patients with hilar biliary tumors, 12 studies compared SEMS with plastic stents, 3 were retrospective in nature, 4 studied new types of biliary stents, 3 compared 2 types of SEMS, 2 were duplicates, and 1 study was
Discussion
The use of SEMS in the management of distal malignant biliary obstruction has become common practice in cases of unresectable tumors. SEMS have the advantage of a larger inner diameter when compared with plastic biliary stents and thus a longer duration of patency, requiring fewer repeat insertions.2, 23, 24, 25, 26 Nonetheless, the use of SEMS is associated with dysfunction caused by tumor ingrowth, overgrowth, blockage by debris, and migration. Covered SEMS were introduced to prevent ingrowth
References (34)
- et al.
Palliation of malignant biliary obstruction: a prospective trial examining impact on quality of life
Gastrointest Endosc
(2002) - et al.
Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction
Lancet
(1992) - et al.
Uncovered versus covered self-expanding metallic stents for inoperable malignant distal biliary obstruction: a prospective randomized multicenter study
Gastrointest Endosc
(2009) - et al.
Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study
Gastrointest Endosc
(2010) - et al.
A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction
Gastrointest Endosc
(2010) - et al.
A randomized controlled trial comparing the covered (CSEMS) versus uncovered self-expandable metal stents (USEMS) for the palliation of malignant distal biliary obstruction (MDBO): interim analysis
Gastrointest Endosc
(2008) - et al.
A randomized controlled comparative study of covered versus uncovered self-expandable metal stent for malignant biliary obstruction
Gastrointest Endosc
(2004) - et al.
Preliminary results of a prospective randomized study of partially covered Wallstents vs noncovered Wallstents
Gastrointest Endosc
(1995) Self-expandable metal stents for malignant distal biliary strictures
Gastrointest Endosc Clin N Am
(2011)- et al.
Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Control Clin Trials
(1996)
Meta-analysis in clinical trials
Control Clin Trials
Percutaneous palliation of non-primary malignant biliary obstruction with covered versus non covered stents: preliminary results of a prospective randomized trial
J Vasc Interv Radiol
Covered versus non-covered biliary stents in percutaneous palliation of primary malignant biliary obstruction: results of a prospective randomized trial
J Vasc Interv Radiol
Plastic or metal stents for malignant stricture of the common bile duct?Results of a randomized prospective study
Gastrointest Endosc
Covered metal versus plastic stents for malignant common bile duct stenosis: a prospective, randomized, controlled trial
Gastrointest Endosc
Self-expanding metal stents confer a survival advantage in the palliation of distal malignant biliary obstruction
Gastrointest Endosc
Expandable metal biliary stents before pancreaticoduodenectomy for pancreatic cancer: a Monte-Carlo decision analysis
Clin Gastroenterol Hepatol
Cited by (157)
Post-ERCP cholecystitis: Incidence, characteristics, and outcomes from a prospective multicenter biliary endoscopy registry
2024, Gastrointestinal EndoscopyReply
2024, GastroenterologyHistory of the Interventional Pancreaticobiliary Endoscopy
2024, Gastrointestinal Endoscopy Clinics of North AmericaResponse
2023, Gastrointestinal EndoscopyPrevention and Management of Complications of Biliary Endoscopy
2022, Gastrointestinal Endoscopy Clinics of North America
Conflicts of interest This author discloses the following: Dr Barkun is a consultant for Boston Scientific Inc, Olympus Canada Inc, and Cook Inc and has also received “at arms-length” grant funding from both Boston Scientific Inc and Cook Inc. The remaining authors disclose no conflicts.