Comparison of Metal and Plastic Stents for Preoperative Biliary Drainage in Resectable and Borderline Resectable Periampullary Cancer: A Meta-Analysis and System Review

J Laparoendosc Adv Surg Tech A. 2018 Sep;28(9):1074-1082. doi: 10.1089/lap.2018.0029. Epub 2018 Apr 18.


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 reintervention 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 (OR) with 95% confidence interval (CI) was calculated to compare the incidence of endoscopic reintervention and stent-related complications between the plastic and metal stents groups. Also, we used RevMan 5.3 to perform the pooled analyses.

Results: Four trials (three randomized controlled trials [RCT] and one prospective clinical trial) with 392 patients were included. One hundred seventy-four patients received metal stents for PBD, and 218 patients received plastic stents. The metal stents group had a significant lower rate of endoscopic reintervention (OR = 0.30, 95% CI = 0.13-0.73, P = .008) and preoperative cholangitis (OR = 3.60, 95% CI = 1.62-7.98, P = .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 = .002) in the metal stents group.

Conclusions: The present meta-analysis revealed that metal stents have significantly lower rate of reintervention 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 malignant distal biliary obstruction.

Keywords: malignant distal biliary obstruction; metal stent; periampullary cancer; plastic stent; preoperative biliary drainage.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review

MeSH terms

  • Ampulla of Vater*
  • Cholangitis / etiology
  • Cholestasis / etiology
  • Cholestasis / surgery*
  • Common Bile Duct Neoplasms / complications*
  • Common Bile Duct Neoplasms / surgery
  • Drainage / adverse effects
  • Drainage / instrumentation*
  • Duodenal Neoplasms / complications*
  • Duodenal Neoplasms / surgery
  • Endoscopy, Digestive System
  • Humans
  • Metals / adverse effects
  • Pancreatic Neoplasms / complications*
  • Pancreatic Neoplasms / surgery
  • Pancreatitis / etiology
  • Plastics / adverse effects
  • Postoperative Complications / etiology
  • Preoperative Care
  • Randomized Controlled Trials as Topic
  • Stents / adverse effects*


  • Metals
  • Plastics