PMID- 37813199 OWN - NLM STAT- MEDLINE DCOM- 20240219 LR - 20240219 IS - 1097-6779 (Electronic) IS - 0016-5107 (Linking) VI - 99 IP - 3 DP - 2024 Mar TI - Fully covered versus partially covered self-expandable metal stents for palliation of distal malignant biliary obstruction: a systematic review and meta-analysis. PG - 314-322.e19 LID - S0016-5107(23)02961-9 [pii] LID - 10.1016/j.gie.2023.10.023 [doi] AB - BACKGROUND AND AIMS: Self-expandable metal stents (SEMSs) are standardly used for distal malignant biliary obstruction (dMBO). Although data suggest that covered versus uncovered SEMSs increase the time to recurrent biliary obstruction (TRBO), no data are available for fully covered (FC) versus partially covered (PC) designs. METHODS: PubMed, Scopus, and Cochrane databases were screened up to January 2023 for studies concerning dMBO treated by an FC- or PC-SEMS and describing adverse events (AEs), recurrences, or TRBO for specific design subpopulations. Pooled proportions or means were calculated using a random-effects model. Several subanalyses were preplanned, including a subanalysis restricted to prospective studies and unresectable diseases. Heterogeneity and publication bias were explored. Standardized differences (d-values) were calculated between groups. RESULTS: From 1290 records, 62 studies (3327 using FC-SEMSs and 2322 using PC-SEMSs) were included. FC- versus PC-SEMSs showed negligible differences in the rate of total AEs (12% vs 9.9%) and all specific AEs, including cholecystitis (2.5% vs 2.6%). In a subanalysis restricted to prospective studies and unresectable diseases, the rate of RBO was comparable between FC-SEMSs (27.3% [95% confidence interval CI, 23.7-31.2], I(2) = 35.34%) and PC-SEMSs (25.3% [95% CI, 20.2-30.7], I(2) = 85.09%), despite small differences (d-values between .186 and .216) in the rate of ingrowth (.5% vs 2.9%) favoring FC-SEMSs and migration (9.8% vs 4.3%) favoring PC-SEMSs. TRBO was shorter for FC-SEMSs (238 days [95% CI, 191-286], I(2) = 63.1%) versus PC-SEMSs (369 days [95% CI, 290-449], I(2) = 71.9%; d-value = .116). CONCLUSIONS: Despite considerable heterogeneity and small standardized differences, PC-SEMSs consistently exhibited longer TRBO than FC-SEMSs across analyses, without any other differences in AE rates, potentially proposing PC-SEMSs as the standard comparator and TRBO as the primary outcome for future randomized studies on dMBO. (Clinical trial registration number: CRD42023393965.). CI - Copyright (c) 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved. FAU - Vanella, Giuseppe AU - Vanella G AD - Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. FAU - Coluccio, Chiara AU - Coluccio C AD - Gastroenterology Department, Morgagni-Pierantoni Hospital, Forli, Italy. FAU - Cucchetti, Alessandro AU - Cucchetti A AD - Gastroenterology Department, Morgagni-Pierantoni Hospital, Forli, Italy; Pancreatobiliary Endoscopy and Endosonography Division, Alma Mater Studiorum University of Bologna, Bologna, Italy. FAU - Leone, Roberto AU - Leone R AD - Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; International MD Program, Vita-Salute San Raffaele University, Milan, Italy. FAU - Dell'Anna, Giuseppe AU - Dell'Anna G AD - Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. FAU - Giuffrida, Paolo AU - Giuffrida P AD - Gastroenterology Department, Morgagni-Pierantoni Hospital, Forli, Italy; Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy. FAU - Abbatiello, Carmela AU - Abbatiello C AD - Gastroenterology Department, Morgagni-Pierantoni Hospital, Forli, Italy; Digestive Disease Postgraduate School, University of Salerno, Italy. FAU - Binda, Cecilia AU - Binda C AD - Gastroenterology Department, Morgagni-Pierantoni Hospital, Forli, Italy. FAU - Fabbri, Carlo AU - Fabbri C AD - Gastroenterology Department, Morgagni-Pierantoni Hospital, Forli, Italy. FAU - Arcidiacono, Paolo Giorgio AU - Arcidiacono PG AD - Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. LA - eng PT - Journal Article PT - Meta-Analysis PT - Review PT - Systematic Review DEP - 20231007 PL - United States TA - Gastrointest Endosc JT - Gastrointestinal endoscopy JID - 0010505 SB - IM MH - Humans MH - Prospective Studies MH - Prosthesis Failure MH - *Self Expandable Metallic Stents MH - *Cholecystitis MH - *Cholestasis/etiology/surgery MH - Stents MH - Treatment Outcome MH - Retrospective Studies COIS- Disclosure The following authors disclosed financial relationships: C. Coluccio: Speaker for Steris. C. Binda: Speaker for Steris, Fujifilm, Boston Scientific, and Q3 Medical. C. Fabbri: Consultant for Boston Scientific; speaker for Steris and Q3 Medical. G. Vanella: Consultant for Boston Scientific. All other authors disclosed no financial relationships. EDAT- 2023/10/10 00:42 MHDA- 2024/02/19 06:43 CRDT- 2023/10/09 19:21 PHST- 2023/06/29 00:00 [received] PHST- 2023/08/28 00:00 [revised] PHST- 2023/10/04 00:00 [accepted] PHST- 2024/02/19 06:43 [medline] PHST- 2023/10/10 00:42 [pubmed] PHST- 2023/10/09 19:21 [entrez] AID - S0016-5107(23)02961-9 [pii] AID - 10.1016/j.gie.2023.10.023 [doi] PST - ppublish SO - Gastrointest Endosc. 2024 Mar;99(3):314-322.e19. doi: 10.1016/j.gie.2023.10.023. Epub 2023 Oct 7.