For malignant biliary obstruction, plastic stents may be cost-effective alternative

November 03, 2016

Preoperative biliary drainage (PBD) with stent placement has been commonly used for patients with malignant biliary obstruction. In PBD, the placement of fully covered self-expandable metal stents (FCSEMSs) may provide better patency duration and a lower incidence of cholangitis compared with plastic stents. But a new study suggests that plastic stents may provide similar outcomes at a potential cost savings. The study, "Metal versus plastic stents for drainage of malignant biliary obstruction before primary surgical resection," is published in the November issue of GIE: Gastrointestinal Endoscopy, the monthly, peer-reviewed journal of the American Society for Gastrointestinal Endoscopy (ASGE).

The researchers prospectively looked at 86 patients with malignant biliary obstruction in multiple centers over a two-year period. Patients with obstructive jaundice were randomly assigned to undergo PBD either with plastic stents or FCSEMS placement.

They found that baseline characteristics were not significantly different between the two groups. Endoscopic stent placement was technically successful in all patients, and procedure-related adverse events were not significantly different between the two groups.

The authors concluded that, in patients with resectable malignant biliary obstruction, the outcomes of PBD with plastic stents and FCSEMSs were similar. Considering the cost-effectiveness, PBD with plastic stents may be preferable to FCSEMS placement.

American Society for Gastrointestinal Endoscopy

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