Research Article
Are Double-Layer Stents Better than Plastic Stents and Self-Expandable Metal Stents in Palliating Malignant Biliary Obstruction? Meta-Analysis and Systematic Review
Harsha Moole1*, Matthew L. Bechtold2, Micheal Cashman3, Fritz H Volmar3, Sonu Dhillon3, David Forcione4 and Srinivas R Puli31Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Illinois, USA
2Division of Gastroenterology and Hepatology, University of Missouri, Columbia, Missouri, USA
3Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
4Interventional Endoscopy Services, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Corresponding Author:
- Harsha Moole, MD
Department of Internal Medicine
University of Illinois College of Medicine Peoria
530 NE Glen Oak Ave, Peoria, Illinois, 61637, USA
Tel: +1 (309) 655-2730
Fax: 001 (309) 655-2755
E-mail: harsha1778@yahoo.co.in
Received Date: June 18, 2016; Accepted Date: July 27, 2016; Published Date: August 03, 2016
Citation: Moole H, Bechtold ML, Cashman M, Volmar FH, Dhillon S, et al. (2016) Are Double-Layer Stents Better than Plastic Stents and Self-Expandable Metal Stents in Palliating Malignant Biliary Obstruction? Meta-Analysis and Systematic Review. J Gastrointest Dig Syst 6:459. doi:10.4172/2161-069X.1000459
Copyright: © 2016 Moole H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background: Double layer stents (DLS) were designed to overcome the limitations of plastic stents (PS) and self-expandable metal stents (SEMS) in palliating inoperable malignant biliary obstructions (MBO). Aims: Primary outcomes are stent patency period, occlusion rates and adverse events. Methods: Study Selection Criteria: Studies using DLS, SEMS and PS for palliation of patients with inoperable MBO. Data collection and extraction: Articles were searched in Pubmed and Ovid. Statistical method: Pooled proportions were calculated using both fixed and random effects model. Results: Initial search identified 374 reference articles, of which 41 were selected and reviewed. Five studies (N=460) for DLS, SEMS and PS which met the inclusion criteria were included in this analysis. Pooled analysis by fixed effects showed DLS patency to be 118.9 days (95% CI=110.4 to 127.4) compared to 77.4 days (95% CI=70.2 to 84.6) in PS and 170.7 days (95% CI=154.4 to 187.0) in SEMS. Stent occlusion rates in DLS, PS and SEMS group were 8.1% (95% CI=7.1 to 9.0), 37.5% (95% CI=33.8 to 41.1) and 19.9% (95% CI=18.1 to 21.7) respectively. Conclusions: In palliating inoperable MBO patients, DLS seem to be superior to PS. SEMS tend to have higher occlusion rates compared to DLS.
