Metal vs plastic stents for preoperative biliary drainage in patients with periampullary cancer: An updated systematic review and meta‐analysis

Background/Purpose Metal stents (MS) are recommended for preoperative biliary drainage (PBD) in patients with periampullary cancer, but whether MS are superior in terms of re‐intervention and direct cost is debatable. This study aimed to compare the effects of MS and PS on the outcomes of patients w...

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Published in:Journal of hepato-biliary-pancreatic sciences Vol. 30; no. 1; pp. 6 - 20
Main Authors: Watanabe, Jun, Miki, Atsushi, Sasanuma, Hideki, Kotani, Kazuhiko, Sata, Naohiro
Format: Journal Article
Language:English
Published: Japan Wiley Subscription Services, Inc 01.01.2023
Subjects:
Cancer
drainage
Drainage - adverse effects
Humans
Meta-analysis
Metals
neoadjuvant therapy
Neoplasms
Pancreatic cancer
pancreatic neoplasms
Plastics
Postoperative Complications - etiology
Stents
Stents - adverse effects
systematic review
drainage
systematic review
pancreatic neoplasms
neoadjuvant therapy
stents
ISSN:1868-6974, 1868-6982, 1868-6982
Online Access:Get full text
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Summary:Background/Purpose Metal stents (MS) are recommended for preoperative biliary drainage (PBD) in patients with periampullary cancer, but whether MS are superior in terms of re‐intervention and direct cost is debatable. This study aimed to compare the effects of MS and PS on the outcomes of patients with periampullary cancer. Methods For this random‐effects meta‐analysis, electronic databases were screened for randomized controlled trials (RCTs) published until January 2022. Subgroup analyses were performed basis on the center type and presence of NAC. Results In this meta‐analysis, seven RCTs (440 participants) were included. MS reduced re‐interventions (risk ratio [RR] = 0.42, 95% confidence interval [CI] = 0.25‐0.72) and direct costs (mean difference = −474 USD, 95% CI = −656 to −292). PBD‐related complications (RR = 0.74, 95% CI = 0.32‐1.71) and postoperative complications (RR = 0.73, 95% CI = 0.45‐1.17) did not differ between MS and PS. Compared PS, MS reduced postoperative complications in high‐volume centers (RR = 0.64, 95% CI = 0.49‐0.84) and PBD‐related complications in patients receiving NAC (RR = 0.29, 95% CI = 0.08‐1.08). Conclusions Metal stents likely reduces re‐interventions and direct costs. Further studies are needed to confirm the effects of MS on the outcomes.
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ISSN:1868-6974
1868-6982
1868-6982
DOI:10.1002/jhbp.1162