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Metal stents provide longer time to recurrent biliary obstruction than plastic stents in malignant biliary obstructionMetal stents may last longer for blocked bile ducts

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Key Takeaway
Note that metal stents offer longer time to recurrence but carry a higher risk of procedure-related adverse events.

This meta-analysis evaluated the efficacy and safety of EUS-HGS with metal stents compared to plastic stents in patients with malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography. The analysis synthesized data from six studies to compare primary and secondary outcomes.

Metal stents were associated with a significantly longer time to recurrent biliary obstruction (TRBO) compared to plastic stents (hazard ratio 1.83; 95% CI 1.42-2.36). Additionally, the rate of recurrent biliary obstruction was significantly higher in the plastic stent group (odds ratio 1.75; 95% CI 1.06-2.88). Clinical success rates and re-intervention success rates showed no significant differences between the two groups.

Safety data indicated a significantly higher rate of total procedure-related adverse events in the metal stent group (odds ratio 0.48; 95% CI 0.30-0.77). While metal stents offer a longer duration before recurrence, they are associated with a higher risk of procedure-related complications. The findings are based on a limited pool of six studies, and the certainty of the evidence is not reported.

How this fits prior evidence

This meta-analysis extends prior evidence regarding stent types for malignant biliary obstruction. It confirms that metal stents provide a longer time to recurrent biliary obstruction compared to plastic stents. This finding aligns with the previously reported evidence that EUS-HGAS provides a significantly longer time to recurrent biliary obstruction than EUS-HGS in malignant biliary obstruction.

When a patient has a blocked bile duct due to a tumor, doctors must choose the right way to keep the passage open. This study looked at two common options: metal stents and plastic stents. The goal is to find a way to keep the duct clear for as long as possible while keeping the patient safe.

The analysis of six studies found that metal stents performed better at keeping the duct open. Patients with metal stents had a significantly longer time before the blockage returned compared to those with plastic stents. They also had a lower rate of the blockage coming back overall.

However, there is a trade-off to consider. The study found that metal stents were linked to a significantly higher rate of procedure-related problems. While metal stents offer more durability, they may come with more complications during the process. Because this data comes from only six studies, patients should talk to their doctors to weigh these specific risks and benefits.

What this means for you:
Metal stents last longer and have fewer recurrences, but they carry a higher risk of procedure complications.

Common questions

How do metal stents compare to plastic stents for blocked bile ducts?

Metal stents were found to keep the bile duct open for a significantly longer time than plastic stents. Additionally, patients with metal stents had a lower rate of the blockage returning. However, the study also found that metal stents were linked to a significantly higher rate of procedure-related complications.

Are there any risks with using a metal stent?

Yes, the study showed that metal stents had a significantly higher rate of procedure-related adverse events compared to plastic stents. While they are more durable, they may involve more complications during the procedure. You should discuss these specific risks with your doctor.

Which stent is better for preventing a recurring blockage?

The data shows that metal stents are more effective at preventing a recurring blockage. Patients with metal stents had a significantly lower rate of recurrence compared to those with plastic stents. This makes them a more durable option for keeping the duct open.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
OBJECTIVES: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an alternative procedure for malignant biliary obstruction after failure of endoscopic retrograde cholangiopancreatography. When performing EUS-HGS, either plastic or metal stents are used, but selection often depends on the discretion of the endoscopist. We compared the efficacy and safety of plastic and metal stents during EUS-HGS. METHODS: We performed a systematic meta-analysis of all relevant articles listed by searching PubMed, Medline, and Web of Science databases. Random-effects or fixed-effects models were used to compare time to recurrent biliary obstruction (TRBO), clinical success rate, adverse event rate, rate of recurrent biliary obstruction, and re-intervention success rate after EUS-HGS with plastic and metal stents. RESULTS: This meta-analysis included six eligible studies. The TRBO of the metal stent group was significantly longer than that of the plastic stent group (hazard ratio 1.83; 95% confidence interval [CI] 1.42-2.36). The total procedure-related adverse event rate of the metal stent group was significantly higher than that of the plastic stent group (odds ratio [OR] 0.48; 95% CI 0.30-0.77). The recurrent biliary obstruction rate of the plastic stent group was significantly higher than that of the metal stent group (OR 1.75; 95% CI 1.06-2.88). No significant difference was found for the clinical success rate or re-intervention success rate. CONCLUSION: In this meta-analysis, metal stents showed longer TRBO, lower recurrent biliary obstruction rate, and higher adverse event rate than plastic stents.
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