Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review

Petra Ga Van Boeckel,Frank P Vleggaar,Peter D Siersema

doi:10.1186/1471-230x-9-96

Petra Ga Van Boeckel, Frank P Vleggaar + Show 1 more

Open Access

https://doi.org/10.1186/1471-230x-9-96

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Journal: BMC Gastroenterology	Publication Date: Dec 1, 2009
Citations: 211	License type: CC BY 2.0

Affiliation: University Medical Center Utrecht

Abstract

BackgroundBenign biliary strictures may be a consequence of surgical procedures, chronic pancreatitis or iatrogenic injuries to the ampulla. Stents are increasingly being used for this indication, however it is not completely clear which stent type should be preferred.MethodsA systematic review on stent placement for benign extrahepatic biliary strictures was performed after searching PubMed and EMBASE databases. Data were pooled and evaluated for technical success, clinical success and complications.ResultsIn total, 47 studies (1116 patients) on outcome of stent placement were identified. No randomized controlled trials (RCTs), one non-randomized comparative studies and 46 case series were found. Technical success was 98,9% for uncovered self-expandable metal stents (uSEMS), 94,8% for single plastic stents and 94,0% for multiple plastic stents. Overall clinical success rate was highest for placement of multiple plastic stents (94,3%) followed by uSEMS (79,5%) and single plastic stents (59.6%). Complications occurred more frequently with uSEMS (39.5%) compared with single plastic stents (36.0%) and multiple plastic stents (20,3%).ConclusionBased on clinical success and risk of complications, placement of multiple plastic stents is currently the best choice. The evolving role of cSEMS placement as a more patient friendly and cost effective treatment for benign biliary strictures needs further elucidation. There is a need for RCTs comparing different stent types for this indication.

Highlights

Benign biliary strictures may be a consequence of surgical procedures, chronic pancreatitis or iatrogenic injuries to the ampulla
Thirteen studies were excluded because they were duplicates and 23 studies because they contained no data on stent placement for benign biliary strictures
This review shows that the most optimal nonsurgical treatment of benign extrahepatic biliary strictures has been demonstrated with multiple plastic stent placement

Summary

Introduction

Benign biliary strictures may be a consequence of surgical procedures, chronic pancreatitis or iatrogenic injuries to the ampulla. Benign biliary strictures occur most frequently as a consequence of a surgical procedure of the gallbladder, mainly cholecystectomy, or common bile duct (CBD) [1]. Other causes include inflammatory conditions, such as chronic pancreatitis and sclerosing cholangitis [2]. Benign strictures of the biliary tract are associated with a broad spectrum of signs and symptoms, ranging from subclinical disease with mild elevation of liver enzymes to complete obstruction with jaundice, pruritus and cholangitis, and biliary cirrhosis [4]. A bilio-digestive anastomosis, or a percutaneously or endoscopically performed dilation with or without stent placement are the most commonly used treatment options for benign biliary strictures[5].

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