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Self-expandable metal stents improve patency and survival in malignant hilar biliary obstructionWhich stent helps people with blocked bile ducts live longer?

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Key Takeaway
Consider SEMSs over plastic stents for endoscopic palliation in unresectable malignant hilar biliary obstruction.

This systematic review and meta-analysis of individual patient data pooled results from 5 randomized controlled trials involving 322 patients with unresectable malignant hilar biliary obstruction requiring palliative endoscopic drainage. The analysis compared self-expandable metal stents (SEMSs) to plastic stents (PSs) for the primary outcomes of stent patency and overall survival, with secondary outcomes including reintervention, technical success, clinical success, and adverse events.

For stent patency, SEMSs showed a significant improvement compared to PSs (hazard ratio [HR], 0.49; 95% CI, 0.35-0.68). Overall survival was also significantly better with SEMSs (HR, 0.60; 95% CI, 0.47-0.78). The need for reintervention was lower with SEMSs (relative risk [RR], 0.76; 95% CI, 0.59-0.97). No significant differences were found between groups for technical success or clinical success.

Safety analysis showed no significant differences in adverse event rates, including pancreatitis, cholecystitis, and cholangitis. The absolute numbers for these events, serious adverse events, discontinuations, and tolerability were not reported. The study did not report the specific follow-up duration for patients.

Key limitations include the meta-analysis being based on a limited number of trials (5 RCTs) with 322 total patients. Absolute event rates and the specific follow-up duration are not reported, and individual trial characteristics are not detailed in this summary. The findings reinforce previous guideline recommendations for preferential use of SEMSs in this setting, but clinicians should consider the evidence base size when applying these results.

When cancer blocks the bile ducts near the liver, it's not just painful—it's life-threatening. Doctors often place small tubes called stents to drain the bile and relieve symptoms, hoping to give people more time and comfort. A fresh look at the best available evidence now suggests the type of stent might make a real difference.

The analysis pooled data from 322 patients across five clinical trials. It found that self-expandable metal stents (SEMS) were linked to significantly longer stent patency—meaning the tube stayed open and working longer—and, importantly, to longer overall survival compared to traditional plastic stents. People with metal stents also needed fewer repeat procedures to clear blockages. The two types were equally successful to place initially and had similar rates of complications like pancreatitis.

This finding supports what many specialists already recommend. However, it's important to remember this is a meta-analysis, a statistical summary of existing studies. The total number of patients is still modest, and the report doesn't give the absolute survival numbers or tell us exactly how long people were followed. While it strengthens the case for metal stents, individual decisions will still depend on a person's specific anatomy and overall health.

What this means for you:
Metal stents linked to longer survival than plastic for inoperable bile duct blockages.

Study Details

Study typeMeta analysis
Sample sizen = 322
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: Malignant hilar biliary obstruction (MHBO) is frequently unresectable, requiring palliative endoscopic drainage. While self-expandable metal stents (SEMSs) are preferred over plastic stents (PSs), evidence regarding stent patency and patient survival remains limited. METHODS: We conducted a meta-analysis of individual patient data (IPD) from randomized controlled trials (RCTs) comparing SEMSs and PSs in unresectable MHBO. Systematic searches were performed in PubMed, Scopus, Web of Science, and the Cochrane Library on June 15, 2025. The primary outcomes were stent patency and overall survival, analyzed using reconstructed Kaplan-Meier curves and stratified Cox models, with hazard ratios (HRs) assessed. Secondary outcomes included reintervention, technical and clinical success, and adverse events, assessed using random-effects risk ratios (RRs), with 95% confidence intervals (CI) RESULTS: Out of 2106 publications screened, five RCTs comprising 322 patients were included. SEMSs significantly improved stent patency (HR, 0.49; 95% CI, 0.35-0.68) and overall survival (HR, 0.60; 95% CI, 0.47-0.78) compared to PSs. Reintervention was lower with SEMSs (RR, 0.76; 95% CI, 0.59-0.97). No significant differences were found in technical and clinical success rates, or in adverse event rates, including pancreatitis, cholecystitis, and cholangitis. CONCLUSIONS: In patients with unresectable MHBO, SEMSs offer superior stent patency and survival compared to PSs, with similar safety and procedural success. These findings reinforce previous guidelines recommending the preferential use of SEMSs for endoscopic palliation in MHBO.
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