Drug eluting vs covered metal stents: which is more beneficial in malignant biliary strictures?

Drug-eluting (DES) and self-expanding metal stents (SEMS) show similar clinical outcomes, as well as reported adverse events and complications, in patients with malignant biliary strictures, reveals a recent meta-analysis.

“Patients with malignant biliary obstruction (MBO) often require transpapillary stenting for symptomatic relief and biliary decompression,” the investigators said.

A meta-analysis was conducted after searching multiple databases for studies that evaluated the clinical outcomes of SEMS and DES in MBO patients. Pooled odds ratio (OR) and the pooled individual outcomes were calculated using random-effects model.

Stent patency and overall survival in days were the primary outcomes, while secondary ones included the individual reported adverse events and complications.

Five studies including 348 patients (175 males and 173 females) met the eligibility criteria. Stent patency had a pooled OR of 1.03 (95 percent confidence interval [CI], 0.68–1.54; p=0.9) and overall survival 1.16 (95 percent CI, 0.63–2.11; p=0.6).

The pooled rate of stent patency was 168.3 days (95 percent CI, 140.7–196.4) for DES and 140.4 days (95 percent CI, 117.6–181.2) for SEMS. For overall survival, the pooled rates were 267.2 (95 percent CI, 206.2–328.2) and 218.2 (95 percent CI, 148.5–287.8) days for DES and SEMS, respectively.

“Plastic stents and uncovered metal stents are now replaced by covered self-expanding metal stents. However, stent occlusion from tumour overgrowth and chronic inflammation continues to be an issue. DES, through an antitumour paclitaxel membrane, have been used to combat this problem,” the investigators noted.