Comparison Of Metal And Plastic Stents For Preoperative Biliary Drainage In Resectable And Borderline Resectable Periampullary Cancer

Aim: The aim of this study was to compare the plastic stents with metal stents for preoperative biliary drainage(PBD)in terms of the rate of endoscopic re-intervention and PBD-related pre-and postoperative complications in patients with resectable and borderline resectable periampullary cancer.Methods: We conducted a comprehensive search of the PubMed,EMBASE,and the Cochrane Library database to identify relevant available articles from their inception to September 2017.The Odds Ratio with 95% confidence interval was calculated to compare the incidence of endoscopic re-intervention and stent-related complications between the plastic and metal stents groups.And we used RevMan 5.3 to perform the pooled analyses.Results: Four trials(3 RCT and 1 prospective clinical trial)with 392 patients were included.174 patients received metal stents for PBD,and 218 patients received plastic stents.The metal stents group had a significant lower rate of endoscopic re-intervention(OR=0.30,95% CI=0.13-0.73,P=0.008)and preoperative cholangitis(OR=3.60,95% CI=1.62-7.98,P=0.002)compared with the plastic stents group.But there was a significantly higher rate of PBD-related pancreatitis(OR=3.60,95% CI=1.62-7.98,P=0.002)in the metal stents group.Conclusions: The present meta-analysis revealed that metal stents have significantly lower rate of re-intervention and cholangitis than plastic stents.But plastic stents have an obvious superiority over metal stents in terms of the incidence of preoperative pancreatitis.More RCTs are required to support this conclusion and provide more detailed information about the complications and treatment.Meanwhile,a uniform standard for the PBD is required in patients with MDBO.