Effect of covered self-expanding metal stents compared with multiple plastic stents on benign biliary stricture: A meta-analysis.

ABSTRACT

BACKGROUND: Endoscopic placement of multiple plastic stents (MPS) has been the first-line treatment for benign biliary stricture (BBS). Covered self-expanding metal stents (cSEMS) have been used in treatment of BBS; however, the efficacy has not been verified. Therefore, we conducted this meta-analysis according to PRISMA guidelines. METHODS: PubMed, Embase, and the Cochrane Library were electronically and manually searched for studies published between January 1, 1990 and April 12, 2017. Of 153 studies screened, 90 were excluded because of duplications. After scanning the title or abstract, only 24 studies were eligible for review and 6 were finally included. The investigators selected publications according to inclusion and exclusion criteria, processed the data, and assessed the quality of the selected studies. The primary endpoint outcome was stricture resolution, and the secondary endpoint outcomes included stricture recurrence rate, the number of endoscopic retrograde cholangiopancreatography (ERCP) sessions, and stent migration. RESULTS: A total of 6 randomized controlled trials with 330 participants were included in the current meta-analysis. There was no significant difference in stricture resolution between the cSEMS and MPS groups (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 0.53-2.07, I = 29%, P = .23, Z = 0.13, P = .90). Similarly, the stricture recurrence rates (OR = 1.39, 95% CI = 0.69-2.81, I = 38%, P = .17, Z = 0.91, P = .36) were comparable between cSEMS and MPS groups. Stent migration rates (OR = 1.71, 95% CI = 0.84-3.50, I = 4%, P = .241, Z = 1.47, P = .14) were similar between cSEMS and MPS groups. There were fewer ERCP sessions in the cSEMS group than in the MPS group. CONCLUSIONS: This meta-analysis showed that cSEMS were comparable to MPS in achieving resolution of BBSs with fewer ERCP procedures.