Metallic versus plastic stents for the management of biliary obstruction: A GRADE-assessed systematic review and meta-analysis.

In 30 seconds

This GRADE-assessed systematic review and meta-analysis compared metallic with plastic stents for benign or malignant biliary obstruction, including randomized and observational studies. Across nine studies and 890 participants, functional success was comparable (RR = 1.03, 95% confidence intervals [CI]: 0.96-1.11), as were overall adverse-event rates in the primary analysis. Adverse events were higher with metallic stents in malignant disease, but not benign disease. Metallic stents were associated with a lower risk of recurrent biliary obstruction in Hartung-Knapp analysis, although substantial heterogeneity limits confidence in this finding. No consistent survival advantage was demonstrated.

Key findings

• Functional success was similar with metallic and plastic stents (RR = 1.03, 95% confidence intervals [CI]: 0.96-1.11).
• Overall adverse events did not differ significantly (RR = 1.37, 95% CI: 0.92-2.03; P = .123).
• In malignant disease, adverse events were higher with metallic stents (RR = 1.74, 95% CI: 1.15-2.63); no difference was found in benign disease.
• Hartung-Knapp analysis found lower recurrent biliary obstruction risk with metallic stents (RR = 0.61, 95% CI: 0.41-0.91), but heterogeneity was substantial.

Why it matters

Stent choice involves balancing technical or functional success, complications, and durability. These pooled findings suggest broadly similar functional success, while indicating that adverse-event patterns may differ by obstruction etiology and that metallic stents could reduce recurrent obstruction. The high heterogeneity and lack of a consistent survival advantage mean these comparisons do not establish a universally preferable stent.

What to keep in mind

The review combined randomized and observational studies, and the recurrent-obstruction analysis had substantial heterogeneity (I2 = 93.1%), limiting certainty.