PMID- 28561199
OWN - NLM
STAT- MEDLINE
DCOM- 20180419
LR  - 20181202
IS  - 1438-8812 (Electronic)
IS  - 0013-726X (Linking)
VI  - 49
IP  - 7
DP  - 2017 Jul
TI  - Efficacy of self-expandable metal stents in management of benign biliary 
      strictures and comparison with multiple plastic stents: a meta-analysis.
PG  - 682-694
LID - 10.1055/s-0043-109865 [doi]
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.
CI  - (c) Georg Thieme Verlag KG Stuttgart . New York.
FAU - Khan, Muhammad Ali
AU  - Khan MA
AD  - Division of Gastroenterology and Hepatology, University of Tennessee Health 
      Science Center, Memphis, Tennessee, USA.
FAU - Baron, Todd H
AU  - Baron TH
AD  - Division of Gastroenterology and Hepatology, University of North Carolina, Chapel 
      Hill, North Carolina, USA.
FAU - Kamal, Faisal
AU  - Kamal F
AD  - Division of Gastroenterology and Hepatology, University of Tennessee Health 
      Science Center, Memphis, Tennessee, USA.
FAU - Ali, Bilal
AU  - Ali B
AD  - Division of Gastroenterology and Hepatology, University of Tennessee Health 
      Science Center, Memphis, Tennessee, USA.
FAU - Nollan, Richard
AU  - Nollan R
AD  - University of Tennessee Health Science Center Library, Memphis, Tennessee, USA.
FAU - Ismail, Mohammad Kashif
AU  - Ismail MK
AD  - Division of Gastroenterology and Hepatology, University of Tennessee Health 
      Science Center, Memphis, Tennessee, USA.
FAU - Tombazzi, Claudio
AU  - Tombazzi C
AD  - Division of Gastroenterology and Hepatology, University of Tennessee Health 
      Science Center, Memphis, Tennessee, USA.
FAU - Artifon, Everson L A
AU  - Artifon ELA
AD  - University of Sao Paulo, Sao Paulo, Brazil.
FAU - Repici, Alessandro
AU  - Repici A
AD  - Humanitas University, Milan, Italy.
FAU - Khashab, Mouen A
AU  - Khashab MA
AD  - Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, 
      Maryland, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20170524
PL  - Germany
TA  - Endoscopy
JT  - Endoscopy
JID - 0215166
RN  - 0 (Plastics)
SB  - IM
CIN - Endoscopy. 2017 Jul;49(7):v23. PMID: 28658687
CIN - Endoscopy. 2018 Jun;50(6):648. PMID: 29843165
MH  - Bile Ducts/*pathology
MH  - Cholecystectomy/adverse effects
MH  - Cholestasis/etiology/*therapy
MH  - Constriction, Pathologic/etiology/therapy
MH  - Humans
MH  - Liver Transplantation/adverse effects
MH  - Pancreatitis, Chronic/complications
MH  - Plastics/adverse effects
MH  - Recurrence
MH  - *Self Expandable Metallic Stents/adverse effects
COIS- Competing interests: Dr. Todd H. Baron is a consultant and speaker for BSCI, 
      Olympus and W.L. Gore. Dr. Mouen A. Khashab is a consultant for Boston 
      Scientific. All other authors have no financial disclosures or conflicts of 
      interest to declare.
EDAT- 2017/06/01 06:00
MHDA- 2018/04/20 06:00
CRDT- 2017/06/01 06:00
PHST- 2017/06/01 06:00 [pubmed]
PHST- 2018/04/20 06:00 [medline]
PHST- 2017/06/01 06:00 [entrez]
AID - 10.1055/s-0043-109865 [doi]
PST - ppublish
SO  - Endoscopy. 2017 Jul;49(7):682-694. doi: 10.1055/s-0043-109865. Epub 2017 May 24.