Anas Renno, MD1, Yousef Abdel-Aziz, MD2, Tamer Ahmed, MD1, Yaseen Alastal, MD, MPH, CMQ1, Javaid Toseef, MD1, Yasir Al-Aboodi, MD, MPH1, Ali Nawras, MD, FACG1
1University of Toledo Medical Center, Toledo, OH; 2University of Tennessee Health Science Center, Memphis, TN
Introduction: In patients with distal malignant biliary obstruction (MBO), endoscopic biliary drainage by using the conventional self-expandable metal stent (cSEMS) is the gold standard established method for palliative treatment. However, there are limited data on the role of the antireflux valve metal stent (ARVMS). The aim of this study is to compare the efficacy and safety of ARVMS and cSEMS.
Methods: We performed an electronic search including PubMed, MEDLINE, EMBASE and Cochrane Library following the Preferred Reporting Items for Systemic Review and Meta-analysis (PRISMA) from inception until April 2019. We included randomized controlled trials (RCTs) that studied the efficacy and safety of ARVMS vs cSEMS deployment in distal malignant biliary obstruction. The selected studies provided data regarding technical and clinical success rates. Adverse events and stent dysfunction were also analyzed. We assessed the risk of biases using Cochrane Collaboration tool to assess the risk of bias.
Results: A total of 3 RCT’s were selected, enrolling 293 patients (147 ARVMS and 146 cSEMS). The rate of technical success between the ARVMS and cSEMS groups was 95.23% and 99.31% [odds ratio (OR) 0.13; 95% Confidence Interval (95% CI) 0.01-1.06, p= 0.06]. The clinical success rate was 91.57% and 89.36% (OR: 1.30; 95% CI: 0.48-3.51, p= 0.61). There was no significant difference in terms of adverse events between ARVMS and cSEMS (OR: 0.61; 95% CI: 0.35-1.05, p= 0.07). Overall, there was no statistical significance in stent dysfunction (OR: 0.77; 95% CI: 0.48-1.24, p= 0.29), however; after performing sub analysis stent migration was significantly higher in ARVMS (OR: 2.76; 95% CI: 1.24-6.17, p= 0.01). Stent occlusion was significantly lower in ARVMS (OR: 0.44; 95% CI: 0.26-0.76, p= 0.003).
Discussion: Our study showed that ARVMS and cSEMS technical and clinical success rates were similar. Adverse events were comparable between two arms. ARVMS was associated with lower risk of stent occlusion. Further randomized controlled trials are required with a higher number of patient population to verify the benefit of ARVMS.
Citation: Anas Renno, MD; Yousef Abdel-Aziz, MD; Tamer Ahmed, MD; Yaseen Alastal, MD, MPH, CMQ; Javaid Toseef, MD; Yasir Al-Aboodi, MD, MPH; Ali Nawras, MD, FACG. P1470 - ANTIREFLUX VALVE METAL STENT VS. CONVENTIONAL SELF EXPANDABLE METAL STENT IN DISTAL MALIGNANT BILIARY OBSTRUCTION: A SYSTEMIC REVIEW AND META-ANALYSIS. Program No. P1470. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.