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• W2162526252 abstract "Background: Plastic and self-expanding metal stents are used to palliate malignant biliary obstruction, yet can be complicated by occlusion. A previous set of meta-analyses by our group showed that no plastic stent design is superior and that adjuvant therapy does not improve stent patency or prolong patient survival. Objectives: To determine the effect of metal stent technologies compared with plastic stent insertion on duration of stent patency and patient survival in malignant biliary obstruction. Methods: Relevant English RCTs (1980-2004) were assessed by 2 reviewers for methodological quality using a validity assessment score created for this analysis. Data were abstracted regarding patient characteristics of stent insertion (ERCP vs. percutaneous) for distal malignant biliary obstruction, excluding hepatic metastases. Only trials with sufficient statistical information were included. The main outcomes were median stent occlusion and median patient survival. The difference of log-transformed median stent patency or survival ratio of the treatment stent vs. control was calculated for each study. Data were pooled using a random effect model and then re-transformed to the original scale to provide pooled estimates and 95% CI. Sensitivity analysis was done. SAS software (v 8.2) was used for statistical analysis. Results: A meta-analysis of 3 trials with 184 patients treated with plastic vs. self-expanding metal stent insertion showed a significant benefit for metal stents in terms of median patency (ratio 0.3, 95% CI 0.131 to 0.599 p = 0.001). A survival advantage was also noted that favored metal stents (0.69, p = 0.03, 95% CI 0.486 to 0.968). Conclusions: The use of metal stents results in a prolonged median patency when compared with plastic, which confirms results of individual trials. The use of SEMS was shown in this meta-analysis to provide a survival advantage when compared to plastic stents–this has never been shown in individual trials, probably due to insufficient statistical power but bears significant clinical implications. Additional high quality clinical data are required to assess this important finding." @default.
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• W2162526252 date "2005-04-01" @default.
• W2162526252 modified "2023-10-10" @default.
• W2162526252 title "Self-Expanding Metal Stents Confer a Survival Advantage in the Palliation of Distal Malignant Biliary Obstruction" @default.
• W2162526252 doi "https://doi.org/10.1016/s0016-5107(05)01221-6" @default.
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