Efficacy and safety of covered versus uncovered self‑expandable metal stents for the palliative treatment of malignant distal biliary stricture: A long‑term retrospective study

Liang Zhu; Zhenwen Wang; Zhiquan Huang; Xueping Yang; Zhengping Yu; Ronglai Cao; Youxiang Chen

doi:10.3892/etm.2023.11996

Efficacy and safety of covered versus uncovered self‑expandable metal stents for the palliative treatment of malignant distal biliary stricture: A long‑term retrospective study

Exp Ther Med. 2023 May 5;25(6):297. doi: 10.3892/etm.2023.11996. eCollection 2023 Jun.

Authors

Liang Zhu^{1

2}, Zhenwen Wang¹, Zhiquan Huang¹, Xueping Yang¹, Zhengping Yu¹, Ronglai Cao¹, Youxiang Chen^{1

2}

Affiliations

¹ Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China.
² Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China.

Abstract

Both covered self-expandable metal stents (CSEMSs) and uncovered self-expandable metal stents (USEMSs) have been tried in the palliation of malignant distal biliary strictures by means of endoscopic retrograde cholangiopancreatography (ERCP); however, the comparison of efficacy and safety between them remains contested. To the best of our knowledge, no similar studies have assessed this in the Chinese population. In the present study, the clinical and endoscopic data of 238 patients (CSEMSs, n=55; USEMSs, n=183) with malignant distal biliary strictures from 2014 to 2019 were collected. The efficacy indicated by mean stent patency, stent patency rate, mean patient survival time and survival rate, and the safety indicated by adverse events after CSEMS or USEMS placement were retrospectively analyzed and compared. The mean stent patency time was significantly longer in the CSEMSs group than that in the USEMSs group (262.8±195.3 days vs. 169.5±155.7 days, P=0.002). The mean patient survival time was significantly longer in the CSEMSs group than that in the USEMSs group (273.9±197.6 days vs. 184.9±167.6 days, P=0.003). The stent patency rate and patient survival rate were significantly higher in the CSEMSs group than those in the USEMSs group at 6 and 12 months, but not at 1 and 3 months. There was no significant difference in stent dysfunction and adverse events between the two groups, although post-ERCP pancreatitis (PEP) occurred more frequently in the CSEMSs group than in the USEMSs group (18.1% vs. 8.8%, P=0.049). In conclusion, CSEMSs were better than USEMSs for malignant distal biliary strictures in terms of stent patency time and patient survival time as well as stent patency rate and patient survival rate in the long term (>6 months). Adverse events in the two groups occurred at a similar rate, although the incidence of PEP was higher in the CSEMSs group.

Keywords: covered self-expandable metal stents; efficacy; malignant distal biliary stricture; safety; uncovered self-expandable metal stents.

Grants and funding

Funding: This study was supported by the National Natural Science Foundation of China (grant no. 82160694), the project of the Jiangxi Department of Science and Technology (grant no. 20202BBGL73109), the project of the Health and Family Planning Commission of Jiangxi Province (grant no. 20195082), the project of Jiangxi Clinical Research Center for Gastroenterology (grant no. 20201ZDG02007) and the Jiangxi Postgraduate Innovation Special Fund Project (grant no. YC2021-S192).