A Cochrane review [Abstract] 1 included 29 studies with a total of over 1 700 subjects. Endoscopic stenting with plastic stents appears to be associated with a reduced risk of complications (RR 0.60, 95% CI 0.45 to 0.81; 3 studies, n=306), but with higher risk of recurrent biliary obstruction prior to death (RR 18.59, 95% CI 5.33 to 64.86; 2 studies, n=256) when compared with surgery. There was a trend towards lower risk of 30-day mortality with plastic stents (RR 0.58, 95% CI 0.32 to 1.04, p=0.07; 3 studies, n=306). One study compared metal stents to surgery and reported lower costs and better quality-of-life with metal stents.
Metal stents were associated with a lower risk of recurrent biliary obstruction than plastic stents (RR 0.48, 95% CI 0.38 to 0.62; 7 studies, n=663). There was no significant difference in risk of technical failure, therapeutic failure, complications or 30-day mortality. When different types of plastic stents were compared to polyethylene stents, only perflouro alkoxy plastic stents had superior outcomes in one study. The addition of an anti-reflux valve improved the patency of Teflon stents.
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