PMID- 26859673
OWN - NLM
STAT- MEDLINE
DCOM- 20160719
LR  - 20181113
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 11
IP  - 2
DP  - 2016
TI  - Covered versus Uncovered Self-Expandable Metal Stents for Managing Malignant 
      Distal Biliary Obstruction: A Meta-Analysis.
PG  - e0149066
LID - 10.1371/journal.pone.0149066 [doi]
LID - e0149066
AB  - AIM: To compare the efficacy of using covered self-expandable metal stents 
      (CSEMSs) and uncovered self-expandable metal stents (UCSEMSs) to treat objective 
      jaundice caused by an unresectable malignant tumor. METHODS: We performed a 
      comprehensive electronic search from 1980 to May 2015. All randomized controlled 
      trials comparing the use of CSEMSs and UCSEMSs to treat malignant distal biliary 
      obstruction were included. RESULTS: The analysis included 1417 patients enrolled 
      in 14 trials. We did not detect significant differences between the UCSEMS group 
      and the CSEMS group in terms of cumulative stent patency (hazard ratio (HR) 0.93, 
      95% confidence interval (CI) 0.19-4.53; p = 0.93, I2 = 0%), patient survival (HR 
      0.77, 95% CI 0.05-10.87; p = 0.85, I2 = 0%), overall stent dysfunction (relative 
      ratio (RR) 0.85, M-H, random, 95% CI 0.57-1.25; p = 0.83, I2 = 63%), the overall 
      complication rate (RR 1.26, M-H, fixed, 95% CI 0.94-1.68; p = 0.12, I2 = 0%) or 
      the change in serum bilirubin (weighted mean difference (WMD) -0.13, IV fixed, 
      95% CI 0.56-0.3; p = 0.55, I2 = 0%). However, we did detect a significant 
      difference in the main causes of stent dysfunction between the two groups. In 
      particular, the CSEMS group exhibited a lower rate of tumor ingrowth (RR 0.25, 
      M-H, random, 95% CI 0.12-0.52; p = 0.002, I2 = 40%) but a higher rate of tumor 
      overgrowth (RR 1.76, M-H, fixed, 95% CI 1.03-3.02; p = 0.04, I2 = 0%). Patients 
      with CSEMSs also exhibited a higher migration rate (RR 9.33, M-H, fixed, 95% CI 
      2.54-34.24; p = 0.008, I2 = 0%) and a higher rate of sludge formation (RR 2.47, 
      M-H, fixed, 95% CI 1.36-4.50; p = 0.003, I2 = 0%). CONCLUSIONS: Our meta-analysis 
      indicates that there is no significant difference in primary stent patency and 
      stent dysfunction between CSEMSs and UCSEMSs during the period from primary stent 
      insertion to primary stent dysfunction or patient death. However, when taking 
      further management for occluded stents into consideration, CSEMSs is a better 
      choice for patients with malignant biliary obstruction due to their removability.
FAU - Li, Jinjin
AU  - Li J
AD  - Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, 
      Huazhong University of Science and Technology, Wuhan, China.
FAU - Li, Tong
AU  - Li T
AD  - Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, 
      Huazhong University of Science and Technology, Wuhan, China.
FAU - Sun, Ping
AU  - Sun P
AD  - Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, 
      Huazhong University of Science and Technology, Wuhan, China.
FAU - Yu, Qihong
AU  - Yu Q
AD  - Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, 
      Huazhong University of Science and Technology, Wuhan, China.
FAU - Wang, Kun
AU  - Wang K
AD  - Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, 
      Huazhong University of Science and Technology, Wuhan, China.
FAU - Chang, Weilong
AU  - Chang W
AD  - Department of Gastrointestinal Surgery, Union hospital, Tongji Medical College, 
      Huazhong University of Science and Technology, Wuhan, China.
FAU - Song, Zifang
AU  - Song Z
AD  - Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, 
      Huazhong University of Science and Technology, Wuhan, China.
FAU - Zheng, Qichang
AU  - Zheng Q
AD  - Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, 
      Huazhong University of Science and Technology, Wuhan, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20160209
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Biliary Tract Neoplasms/complications/mortality/surgery
MH  - Cholestasis/etiology/mortality/*surgery
MH  - Humans
MH  - *Self Expandable Metallic Stents/adverse effects
MH  - Stents
PMC - PMC4747571
COIS- Competing Interests: The authors have declared that no competing interests exist
EDAT- 2016/02/10 06:00
MHDA- 2016/07/20 06:00
PMCR- 2016/02/09
CRDT- 2016/02/10 06:00
PHST- 2015/09/16 00:00 [received]
PHST- 2016/01/27 00:00 [accepted]
PHST- 2016/02/10 06:00 [entrez]
PHST- 2016/02/10 06:00 [pubmed]
PHST- 2016/07/20 06:00 [medline]
PHST- 2016/02/09 00:00 [pmc-release]
AID - PONE-D-15-40915 [pii]
AID - 10.1371/journal.pone.0149066 [doi]
PST - epublish
SO  - PLoS One. 2016 Feb 9;11(2):e0149066. doi: 10.1371/journal.pone.0149066. 
      eCollection 2016.