BILIARY METAL STENTS IN PATIENTS WITH MALIGNANT JAUNDICE AND CBD STRICTURE: A RETROSPECTIVE COHORT STUDY COMPARING UNCOVERED, PARTIALLY COVERED AND FULLY COVERED STENTS

Aims:

Endoscopic transpapillary biliary drainage is the treatment of choice for obstructive jaundice caused by malignant strictures. Different types of self-expanding metal stents (SEMS) are available: fully covered (FC), partially covered (PC) and uncovered (UC). The advantage of metal compared to plastic prostheses is the reduced risk of rehospitalization and complications expecially in patients expected to survive for more than 3 months. However what is the most effective type of metal prosthesis is still debated. The aim was to evaluate the reintervention rate after positioning of metal stents, comparing FC versus PC versus UC SEMS.

Methods:

Retrospective single-center cohort study including patients undergoing ERCP with positioning of SEMS for the first time for CBD malignant stenosis. A repeated ERCP was indicated in case of jaundice and/or cholangitis. T-test and Fisher's test was used for comparison of continuous and categorical variables. Reintervention probability was calculated with Kaplan-Meier curve, Cox analysis was employed to calculate hazard ratios (HR).

Results:

321 patients (63 FC, 55 PC, 203 UC) were included in this preliminary analysis,(mean age 69.2 ± 11.8 years, 52.6% males); 90.3% had pancreatic cancer, 3.7% cholangiocarcinoma, 6% had ampullary tumors or pancreatic neuroendocrine tumors. 29.3% patients were metastatic, 47% locally advanced, 23.7% were surgically resectable. Overall reintervention rate for FC vs. PC vs. UC SEMS was respectively 31.7% vs. 12.7% vs. 30%. Main reason for ERCP repetition was occlusion due to sludge and ingrowth in UC stents and occlusion due to sludge and displacement in FC. Patients with partially covered SEMS vs. fully covered or uncovered SEMS had a HR of 0.49 (95% CI 0.27 – 0.88 P = 0.058) for repetition of ERCP.

Conclusions:

To our knowledge, this is the first study comparing all three different types of SEMS to each other in terms of reintervention rate in patients with malignant jaundice. The 51% reduced risk of reintervention after PC SEMS positioning should encourage controlled studies to verify their higher benefit of this stent compared to FC and UC SEMS.