Avicenna journal of medicine · 2026
Covered Self-Expandable Metallic Stents versus Multiple Plastic Stents for Benign Biliary Strictures: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis.
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Nayfeh Tarek, Majzoub Abdul Monaem, Aboursheid Tarek, Malik Alexander, Osman Karim, Hassett Leslie, Mousa Jehan, Malandris Konstantinos, Noureddin Nabil, Beran Azizullah Ahmadallah, Kamal Faisal, Saleem Nasir
Аннотация
PURPOSE: We aim to compare the benefits, harms, and costs of multiple plastic stents (MPS) versus covered self-expandable metallic stents (CSEMS) in the treatment of benign biliary strictures (BBS).
METHODS: A comprehensive database search through June 6, 2024 identified randomized controlled trials (RCT) involving adult patients with BBS comparing MPS to CSEMS in terms of stricture resolution, recurrence, technical success, number of required procedures and stents, treatment duration, all-cause mortality, adverse events, and stent migration. We utilized the Cochrane Risk of Bias (RoB) tool2 for study quality assessment. Meta-analysis following the random effects model was performed.
RESULTS: After screening 365 references, we included 7 RCTs (high RoB) involving 594 patients. Most reported stricture etiology is chronic pancreatitis (52.4%), followed by orthotopic liver transplant (40.5%). Compared with MPS, CSEMS achieved similar efficacy and safety. However, CSEMS required fewer procedures (mean difference [MD]: -1.84 [-2.56 to -1.11]; I 2 = 76%) and stents (MD: -6.04 [-9.55 to -2.52]; I 2 = 93%), amounting for shorter duration of treatment (MD: -119.02 days [-137.41 to -100.62]; I 2 = 96%) and savings in costs between 41 and 57% with absolute savings of 4,019$ to 9,192$ favoring CSEMS. All outcomes had a low to very low certainty of evidence (CoE), except for technical success and stricture resolution (moderate CoE).
CONCLUSION: Our analysis suggests that CSEMSs are comparable to MPSs in terms of efficacy and safety. However, it shows that CSEMSs are more cost-effective. Sample size calculations from our analyses can guide the design of future studies to validate the safety profiles and determine the feasibility of the two modalities.
METHODS: A comprehensive database search through June 6, 2024 identified randomized controlled trials (RCT) involving adult patients with BBS comparing MPS to CSEMS in terms of stricture resolution, recurrence, technical success, number of required procedures and stents, treatment duration, all-cause mortality, adverse events, and stent migration. We utilized the Cochrane Risk of Bias (RoB) tool2 for study quality assessment. Meta-analysis following the random effects model was performed.
RESULTS: After screening 365 references, we included 7 RCTs (high RoB) involving 594 patients. Most reported stricture etiology is chronic pancreatitis (52.4%), followed by orthotopic liver transplant (40.5%). Compared with MPS, CSEMS achieved similar efficacy and safety. However, CSEMS required fewer procedures (mean difference [MD]: -1.84 [-2.56 to -1.11]; I 2 = 76%) and stents (MD: -6.04 [-9.55 to -2.52]; I 2 = 93%), amounting for shorter duration of treatment (MD: -119.02 days [-137.41 to -100.62]; I 2 = 96%) and savings in costs between 41 and 57% with absolute savings of 4,019$ to 9,192$ favoring CSEMS. All outcomes had a low to very low certainty of evidence (CoE), except for technical success and stricture resolution (moderate CoE).
CONCLUSION: Our analysis suggests that CSEMSs are comparable to MPSs in terms of efficacy and safety. However, it shows that CSEMSs are more cost-effective. Sample size calculations from our analyses can guide the design of future studies to validate the safety profiles and determine the feasibility of the two modalities.