PMID- 37201725
OWN - NLM
STAT- MEDLINE
DCOM- 20230925
LR  - 20231027
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 98
IP  - 4
DP  - 2023 Oct
TI  - Uncovered versus fully covered self-expandable metal stents for the management of 
      distal malignant biliary obstruction.
PG  - 577-584.e4
LID - S0016-5107(23)02569-5 [pii]
LID - 10.1016/j.gie.2023.05.047 [doi]
AB  - BACKGROUND AND AIM: Self-expandable metal stents (SEMSs) are widely used for 
      palliation of distal malignant biliary obstruction (dMBO). However, previous 
      studies comparing the outcomes between uncovered SEMSs (UCSEMSs) and fully 
      covered SEMSs (FCSEMSs) report conflicting results. This large cohort study aimed 
      to compare the clinical outcomes between UCSEMSs and FCSEMSs for dMBO. METHODS: A 
      retrospective cohort study was performed in patients with dMBO who underwent 
      either UCSEMS or FCSEMS placement between May 2017 and May 2021. Primary outcomes 
      were rates of clinical success, adverse events (AEs), and unplanned endoscopic 
      reintervention. Secondary outcomes were types of AEs, intervention-free stent 
      patency, and management and outcomes of stent occlusion. RESULTS: The cohort 
      included 454 patients (364 in the UCSEMS group and 90 in the FCSEMS group). 
      Median follow-up duration was 9.6 months and was similar between the 2 groups. 
      Use of UCSEMSs and FCSEMSs had comparable clinical success (P = .250). However, 
      use of UCSEMSs had significantly higher rates of AEs (33.5% vs 21.1%; P = .023) 
      and unplanned endoscopic reintervention (27.0% vs 11.1%; P = .002). UCSEMSs had a 
      higher rate of stent occlusion (26.9% vs 8.9%; P < .001) and shorter median time 
      to stent occlusion (4.4 months vs 10.7 months; P = .002). Stent 
      reintervention-free survival was higher in the FCSEMS group. FCSEMSs had a 
      significantly higher rate of stent migration (7.8% vs 1.1%; P < .001), but 
      patients in the FCSEMS group had similar rates of cholecystitis (.3% vs 1.1%; P = 
      .872) and post-ERCP pancreatitis (6.3% vs 6.6%; P = .90). When UCSEMSs did 
      occlude, placement of a coaxial plastic stent had a higher rate of stent 
      reocclusion compared with coaxial SEMS placement (46.7% vs 19.7%; P = .007). 
      CONCLUSION: FCSEMSs should be considered for the palliation of dMBO because of 
      lower rates of AEs, longer patency rates, and lower rates of unplanned endoscopic 
      intervention.
CI  - Copyright (c) 2023 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Ghazi, Rabih
AU  - Ghazi R
AD  - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, 
      USA.
FAU - AbiMansour, Jad P
AU  - AbiMansour JP
AD  - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, 
      USA.
FAU - Mahmoud, Tala
AU  - Mahmoud T
AD  - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, 
      USA.
FAU - Martin, John A
AU  - Martin JA
AD  - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, 
      USA.
FAU - Law, Ryan J
AU  - Law RJ
AD  - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, 
      USA.
FAU - Levy, Michael J
AU  - Levy MJ
AD  - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, 
      USA.
FAU - Abu Dayyeh, Barham K
AU  - Abu Dayyeh BK
AD  - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, 
      USA.
FAU - Storm, Andrew C
AU  - Storm AC
AD  - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, 
      USA.
FAU - Petersen, Bret T
AU  - Petersen BT
AD  - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, 
      USA.
FAU - Chandrasekhara, Vinay
AU  - Chandrasekhara V
AD  - Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, 
      USA.
LA  - eng
PT  - Journal Article
DEP - 20230516
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
MH  - Humans
MH  - Cohort Studies
MH  - Retrospective Studies
MH  - *Self Expandable Metallic Stents/adverse effects
MH  - Stents/adverse effects
MH  - *Cholestasis/etiology/surgery
EDAT- 2023/05/19 01:04
MHDA- 2023/09/25 06:42
CRDT- 2023/05/18 19:27
PHST- 2023/01/09 00:00 [received]
PHST- 2023/05/02 00:00 [revised]
PHST- 2023/05/11 00:00 [accepted]
PHST- 2023/09/25 06:42 [medline]
PHST- 2023/05/19 01:04 [pubmed]
PHST- 2023/05/18 19:27 [entrez]
AID - S0016-5107(23)02569-5 [pii]
AID - 10.1016/j.gie.2023.05.047 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2023 Oct;98(4):577-584.e4. doi: 10.1016/j.gie.2023.05.047. 
      Epub 2023 May 16.