Self expanding metal stents versus plastic stents after endoscopic drainage of malignant distal biliary obstructions with focus on complication rates – a retrospective 10-year analysis from a tertiary referral center

Aims Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred method for drainage of malignant distal biliary obstruction (MDBO). While studies have shown that self-expanding metal stents (SEMS) offer advantages, such as longer stent patency, there have been conflicting results regarding complication rates. This study compares complication rates in patients with MDBO undergoing ERCP with SEMS or 10-French plastic stent (PS) insertion over a 10-year period at a tertiary referral center.

Methods We evaluated all MDBO patients with first-time in-house single-stent insertion by ERCP between 01/2010 and 09/2020 excluding stent changes. Overall and specific complication rates – including bleeding, cholangitis, cholecystitis, pancreatitis, perforation, stent occlusion and stent dislocation were assessed in time frames after 80, 160 and 240 days of insertion.

Results Overall 917 patients with biliary stenosis were screened from which 203 patients with MDBO were finally included – 129 with 10-French PS and 74 with SEMS. After adjustment for potential confounders, the overall complication rates did not show significant differences after 80 (OR=1.711; 95% CI=0.857-3.417; p=0.128) and 160 days (OR=1.697; 95% CI=0.868-3.318; p=0.122). However, we found that SEMS were associated with a significantly higher rate of overall complications compared to PS after 240 days (OR=2.284; 95% CI=1.188–4.393; p=0.013). PS showed a significantly higher rate of stent occlusions after 160 days (p=0.038) whereas higher rates of stent dislocations were observed in the SEMS group after 240 days (p=0.006). We observed no significant differences in bleeding, cholangitis, cholecystitis, pancreatitis and perforation between the two groups across all time frames (80, 160 and 240 days).

Conclusions Our study suggests that in MDBO SEMS-placement and 10-Fr-Plastic-Stent placement show similar complication rates in the short-term (80 days). In the mid-term (160 days), PS show a higher rate of stent occlusions. Whereas SEMS might be associated with an higher complication rate mainly due to higher rates of stent dislocation in the long-term (240 days). This implicates that patients with PS should be rescheduled for stent exchange after 80 days but also patients with SEMS should be scheduled for reevaluation and stent-exchange before 240 days.

Publication History

Article published online:
27 March 2025