83 - Outcomes of Percutaneous Uncovered Metallic Stent Placement for Malignant Biliary Obstruction: A Systematic Review

Purpose: The aim of this study was to determine the technical success, stent patency rates, and complications related to uncovered metallic biliary stent placement for malignant biliary obstruction in the current literature.

Materials and Methods: This systematic review was performed using the Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines. Articles were identified using the medical subject heading terms: percutaneous, biliary stent, AND placement. The query yielded 891 articles (193 and 698 articles in EMBASE and Pubmed, respectively), 18 of which were included in the final analysis after excluding duplicate articles, case reports, and non-relevant articles. The Newcastle-Ottawa Quality Assessment Scale was used to appraise article quality. Sixteen of the 18 articles were rated as “poor”, while 2 received a “fair” rating. Due to data heterogeneity, meta-analysis was not performed. Patient demographics, technical success rate, procedure outcomes regarding patency rates and number of re-interventions, and complications were recorded. Complications were classified as “major” if they resulted in blood transfusion or additional invasive procedures or were reported as such in the literature. Complications that did not meet these criteria were classified as “minor”.

Results: A total of 1453 patients (677 female; weighted age: 66.8 years) underwent biliary stent placement. The weighted technical success rate was 97.7%. The incidence of stent occlusion was 13.5%, with 6.6% of patients requiring further intervention to maintain patency. Weighted mean time to stent occlusion was 83.9 days. Post-stent biliary drains were placed in 3.9% of cases. There were 259 (17.8%) complications of which 93 were classified as major. The most common complications were pancreatitis (6.4%), cholangitis (4.9%), and bleeding (3.9%). In cases of bleeding (56), 5.1% of patients needed a blood transfusion and 17.9% required a procedure to treat bleeding. Other complications included sepsis, peritonitis/bile leak, pneumonia, pneumothorax, and cholecystitis (1.1%, 0.7%, 0.6%, 0.1%, and 0.1%, respectively). There were 6 (0.4%) deaths associated with the stent placement procedure.

Conclusion: Percutaneous uncovered metallic stent placement for malignant biliary obstruction has a high technical success rate with a mortality risk less than 1%. Although nearly one in five patients experienced procedure-related complications including pancreatitis, cholangitis, and bleeding, most cases were minor.