Aims Covered or uncovered self-expandable metallic stents (SEMS) placed in patients with
malignant biliary obstruction (MBO) can occlude in 19-40%, but optimal management
is unclear. However data suggest that the higher cost of an initial SEMS may be mitigated
by the reduced need for repeated ERCP . We summarize the current evidence regarding
management of occluded SEMS in patients with malignant biliary obstruction
Methods We searched Pubmed, Embase, and Web of Science using pre-defined criteria, and reviewed
bibliographies of included studies. Data were independently abstracted by two investigators,
and analyzed using RevMan. We compared strategies of second SEMS versus plastic stents
with respect to the following outcomes: rate of stent re-occlusion, duration of second
stent patency, and survival. Pooled analysis wasperformedusing a Review manager (Cochrane)
software.
Results Ten retrospective were included. Management options were placement of an uncovered
SEMS (n=125), covered SEMS (n=106), plastic stent (n=135), percutaneous biliary drain
(n=7). Relative risk of re-occlusion was not significantly different in patients with
second SEMS compared to plastic stents (RR 1.24, 95% CI 0.92, 1.67, I2= 0, p 0.16).
Duration of second stent patency was not significantly different between patients
who received second SEMS versus plastic stents (WMD) 0.46, 95% CI −0.30, 1.23, I2=83%).
Survival was not significantly different among patients who received plastic stents
versus SEMS (WMD −1.13, 95% CI −2.33, 0.07, I2 86%, p 0.07
Conclusions According to our results, In patients with malignant biliary obstruction and occluded
SEMS, a strategy of placing a plastic stent may be as effective as second SEMS. Limitations
of these findings were that all studies were retrospective and heterogeneity between
studies was detected for two of the outcomes.
