Efficacy of self-expandable metal stents in management of benign biliary strictures and comparison with multiple plastic stents

A meta-analysis

Muhammad Ali Khan, Todd H. Baron, Faisal Kamal, Bilal Ali, Richard Nollan, Mohammad Ismail, Claudio Tombazzi, Everson L.A. Artifon, Alessandro Repici, Mouen A. Khashab

Research output: Contribution to journalReview article

12 Citations (Scopus)

Abstract

Background and study aims There is burgeoning interest in the utilization of covered self-expandable metal stents (CSEMSs) for managing benign biliary stricture (BBS). This systematic review and meta-analysis evaluated cumulative stricture resolution and recurrence rates using CSEMSs and compared performance of CSEMSs and multiple plastic stents (MPS) in BBS management. Method Searches in several databases identified studies including≥10 patients that utilized CSEMSs for BBS treatment. Weighted pooled rates were calculated for stricture resolution and recurrence. Pooled risk ratios (RRs) comparing CSEMSs with MPS were calculated for stricture resolution, stricture recurrence, and adverse events. Pooled difference in means was calculated to compare number of endoscopic retrograde cholangiopancreatographies (ERCPs) in each group. Results The meta-analysis included 22 studies with 1298 patients. Weighted pooled rate for BBS resolution with CSEMS was 83% (95% confidence limits [95%CLs] 78%, 87%; I 2 =72%). On meta-regression analysis, resolution in chronic pancreatitis patients and post-orthotopic liver transplant patients were significant predictors of heterogeneity. Weighted pooled rate for stricture recurrence with CSEMSs was 16% (11%, 22%). Overall rate of adverse events requiring intervention and/or hospitalization was 15%. Four randomized controlled trials with 213 patients compared CSEMSs with MPS: the pooled RRs for stricture resolution, recurrence, and adverse events were 1.07 (0.97, 1.18), 0.88 (0.48, 1.63), and 1.16 (0.71, 1.88), respectively with no heterogeneity. Pooled difference in means for number of ERCPs was-1.71 (-2.33,-1.09) in favor of CSEMS. Conclusions CSEMSs appear to have excellent efficacy in BBS management. They are as effective as MPS but require fewer ERCPs to achieve clinical success.

Original languageEnglish (US)
Pages (from-to)682-694
Number of pages13
JournalEndoscopy
Volume49
Issue number7
DOIs
StatePublished - Jul 1 2017

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Plastics
Stents
Meta-Analysis
Pathologic Constriction
Endoscopic Retrograde Cholangiopancreatography
Recurrence
Self Expandable Metallic Stents
Odds Ratio
Chronic Pancreatitis
Hospitalization
Randomized Controlled Trials
Regression Analysis
Databases
Transplants
Liver

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Efficacy of self-expandable metal stents in management of benign biliary strictures and comparison with multiple plastic stents : A meta-analysis. / Khan, Muhammad Ali; Baron, Todd H.; Kamal, Faisal; Ali, Bilal; Nollan, Richard; Ismail, Mohammad; Tombazzi, Claudio; Artifon, Everson L.A.; Repici, Alessandro; Khashab, Mouen A.

In: Endoscopy, Vol. 49, No. 7, 01.07.2017, p. 682-694.

Research output: Contribution to journalReview article

Khan, Muhammad Ali ; Baron, Todd H. ; Kamal, Faisal ; Ali, Bilal ; Nollan, Richard ; Ismail, Mohammad ; Tombazzi, Claudio ; Artifon, Everson L.A. ; Repici, Alessandro ; Khashab, Mouen A. / Efficacy of self-expandable metal stents in management of benign biliary strictures and comparison with multiple plastic stents : A meta-analysis. In: Endoscopy. 2017 ; Vol. 49, No. 7. pp. 682-694.
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abstract = "Background and study aims There is burgeoning interest in the utilization of covered self-expandable metal stents (CSEMSs) for managing benign biliary stricture (BBS). This systematic review and meta-analysis evaluated cumulative stricture resolution and recurrence rates using CSEMSs and compared performance of CSEMSs and multiple plastic stents (MPS) in BBS management. Method Searches in several databases identified studies including≥10 patients that utilized CSEMSs for BBS treatment. Weighted pooled rates were calculated for stricture resolution and recurrence. Pooled risk ratios (RRs) comparing CSEMSs with MPS were calculated for stricture resolution, stricture recurrence, and adverse events. Pooled difference in means was calculated to compare number of endoscopic retrograde cholangiopancreatographies (ERCPs) in each group. Results The meta-analysis included 22 studies with 1298 patients. Weighted pooled rate for BBS resolution with CSEMS was 83{\%} (95{\%} confidence limits [95{\%}CLs] 78{\%}, 87{\%}; I 2 =72{\%}). On meta-regression analysis, resolution in chronic pancreatitis patients and post-orthotopic liver transplant patients were significant predictors of heterogeneity. Weighted pooled rate for stricture recurrence with CSEMSs was 16{\%} (11{\%}, 22{\%}). Overall rate of adverse events requiring intervention and/or hospitalization was 15{\%}. Four randomized controlled trials with 213 patients compared CSEMSs with MPS: the pooled RRs for stricture resolution, recurrence, and adverse events were 1.07 (0.97, 1.18), 0.88 (0.48, 1.63), and 1.16 (0.71, 1.88), respectively with no heterogeneity. Pooled difference in means for number of ERCPs was-1.71 (-2.33,-1.09) in favor of CSEMS. Conclusions CSEMSs appear to have excellent efficacy in BBS management. They are as effective as MPS but require fewer ERCPs to achieve clinical success.",
author = "Khan, {Muhammad Ali} and Baron, {Todd H.} and Faisal Kamal and Bilal Ali and Richard Nollan and Mohammad Ismail and Claudio Tombazzi and Artifon, {Everson L.A.} and Alessandro Repici and Khashab, {Mouen A.}",
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T1 - Efficacy of self-expandable metal stents in management of benign biliary strictures and comparison with multiple plastic stents

T2 - A meta-analysis

AU - Khan, Muhammad Ali

AU - Baron, Todd H.

AU - Kamal, Faisal

AU - Ali, Bilal

AU - Nollan, Richard

AU - Ismail, Mohammad

AU - Tombazzi, Claudio

AU - Artifon, Everson L.A.

AU - Repici, Alessandro

AU - Khashab, Mouen A.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background and study aims There is burgeoning interest in the utilization of covered self-expandable metal stents (CSEMSs) for managing benign biliary stricture (BBS). This systematic review and meta-analysis evaluated cumulative stricture resolution and recurrence rates using CSEMSs and compared performance of CSEMSs and multiple plastic stents (MPS) in BBS management. Method Searches in several databases identified studies including≥10 patients that utilized CSEMSs for BBS treatment. Weighted pooled rates were calculated for stricture resolution and recurrence. Pooled risk ratios (RRs) comparing CSEMSs with MPS were calculated for stricture resolution, stricture recurrence, and adverse events. Pooled difference in means was calculated to compare number of endoscopic retrograde cholangiopancreatographies (ERCPs) in each group. Results The meta-analysis included 22 studies with 1298 patients. Weighted pooled rate for BBS resolution with CSEMS was 83% (95% confidence limits [95%CLs] 78%, 87%; I 2 =72%). On meta-regression analysis, resolution in chronic pancreatitis patients and post-orthotopic liver transplant patients were significant predictors of heterogeneity. Weighted pooled rate for stricture recurrence with CSEMSs was 16% (11%, 22%). Overall rate of adverse events requiring intervention and/or hospitalization was 15%. Four randomized controlled trials with 213 patients compared CSEMSs with MPS: the pooled RRs for stricture resolution, recurrence, and adverse events were 1.07 (0.97, 1.18), 0.88 (0.48, 1.63), and 1.16 (0.71, 1.88), respectively with no heterogeneity. Pooled difference in means for number of ERCPs was-1.71 (-2.33,-1.09) in favor of CSEMS. Conclusions CSEMSs appear to have excellent efficacy in BBS management. They are as effective as MPS but require fewer ERCPs to achieve clinical success.

AB - Background and study aims There is burgeoning interest in the utilization of covered self-expandable metal stents (CSEMSs) for managing benign biliary stricture (BBS). This systematic review and meta-analysis evaluated cumulative stricture resolution and recurrence rates using CSEMSs and compared performance of CSEMSs and multiple plastic stents (MPS) in BBS management. Method Searches in several databases identified studies including≥10 patients that utilized CSEMSs for BBS treatment. Weighted pooled rates were calculated for stricture resolution and recurrence. Pooled risk ratios (RRs) comparing CSEMSs with MPS were calculated for stricture resolution, stricture recurrence, and adverse events. Pooled difference in means was calculated to compare number of endoscopic retrograde cholangiopancreatographies (ERCPs) in each group. Results The meta-analysis included 22 studies with 1298 patients. Weighted pooled rate for BBS resolution with CSEMS was 83% (95% confidence limits [95%CLs] 78%, 87%; I 2 =72%). On meta-regression analysis, resolution in chronic pancreatitis patients and post-orthotopic liver transplant patients were significant predictors of heterogeneity. Weighted pooled rate for stricture recurrence with CSEMSs was 16% (11%, 22%). Overall rate of adverse events requiring intervention and/or hospitalization was 15%. Four randomized controlled trials with 213 patients compared CSEMSs with MPS: the pooled RRs for stricture resolution, recurrence, and adverse events were 1.07 (0.97, 1.18), 0.88 (0.48, 1.63), and 1.16 (0.71, 1.88), respectively with no heterogeneity. Pooled difference in means for number of ERCPs was-1.71 (-2.33,-1.09) in favor of CSEMS. Conclusions CSEMSs appear to have excellent efficacy in BBS management. They are as effective as MPS but require fewer ERCPs to achieve clinical success.

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