Department of Internal Medicine, Mayo Clinic, College of Medicine, Rochester, Minnesota, USA.
Gastrointest Endosc. 2011 Aug;74(2):321-327.e1-3. doi: 10.1016/j.gie.2011.03.1249. Epub 2011 Jun 17.
Self-expandable metal stents (SEMSs) are used for palliation of malignant biliary obstruction.
We performed a meta-analysis to compare stent patency and stent survival of covered SEMSs (CSEMSs) and uncovered SEMSs (USEMSs) in patients with unresectable distal malignant biliary obstruction.
Meta-analysis.
Tertiary-care facility.
A comprehensive search of several databases (from each database's earliest inclusive dates to November 2010, any language, and any population) was conducted. The search identified 337 potential abstracts and titles, of which 16 were retrieved in full text. Review of references identified 17 additional studies. We found 5 multicenter, randomized trials involving 781 patients.
Placement of covered and uncovered SEMSs for treatment of distal malignant biliary obstruction.
Stent patency, stent survival, patient survival, and cause for stent dysfunction (ingrowth, overgrowth, migration, and sludge formation).
The median length of follow-up was 212 days. Compared with USEMSs, CSEMSs were associated with significantly prolonged stent patency (weighted mean difference [WMD] 60.56 days; 95% confidence interval [CI], 25.96, 95.17; I² = 0%) and longer stent survival (WMD 68.87 days; 95% CI, 25.64, 112.11; I(2) = 79%). Stent migration, tumor overgrowth, and sludge formation were significantly higher with CSEMSs (relative risk [RR] 8.11; 95% CI, 1.47, 44.76; I² = 0%), (RR 2.02; 95% CI, 1.08, 3.78; I² = 0%), (RR 2.89; 95% CI, 1.27, 6.55; I² = 0%).
Relatively low number of studies available and the fact that 2 of the 5 studies were from one institution. Also, the limited availability of some stents used in the trials may limit the applicability of these results.
CSEMSs have a significantly longer duration of patency compared with USEMSs in patients with distal malignant biliary obstruction. Stent dysfunction occurs at a similar rate, although there is a trend toward later obstruction with CSEMSs.
自膨式金属支架（SEMS）用于缓解恶性胆道梗阻。
我们进行了一项荟萃分析，以比较不可切除的远端恶性胆道梗阻患者中覆膜自膨式金属支架（CSEMS）和无覆膜自膨式金属支架（USEMS）的支架通畅率和支架生存率。
荟萃分析。
三级保健机构。
对几个数据库进行了全面检索（从每个数据库的最早包含日期到 2010 年 11 月，任何语言，任何人群）。共检索到 337 篇潜在的摘要和标题，其中 16 篇全文被检索到。对参考文献的回顾确定了另外 17 项研究。我们发现了 5 项多中心随机试验，涉及 781 例患者。
放置覆膜和无覆膜自膨式金属支架治疗远端恶性胆道梗阻。
支架通畅率、支架生存率、患者生存率和支架功能障碍的原因（内生长、过度生长、迁移和淤泥形成）。
中位随访时间为 212 天。与 USEMS 相比，CSEMS 与显著延长的支架通畅率（加权均数差[WMD]60.56 天；95%置信区间[CI]，25.96，95.17；I²=0%）和更长的支架生存率（WMD 68.87 天；95%CI，25.64，112.11；I²=79%）相关。CSEMS 支架迁移、肿瘤过度生长和淤泥形成的发生率明显更高（相对风险[RR]8.11；95%CI，1.47，44.76；I²=0%）、（RR 2.02；95%CI，1.08，3.78；I²=0%）、（RR 2.89；95%CI，1.27，6.55；I²=0%）。
可用的研究数量相对较少，其中 5 项研究中有 2 项来自一个机构。此外，试验中使用的一些支架的可用性有限，可能限制了这些结果的适用性。
在远端恶性胆道梗阻患者中，CSEMS 的通畅时间明显长于 USEMS。尽管 CSEMS 有更晚阻塞的趋势，但支架功能障碍的发生率相似。
