Outcome of metal vs plastic stents for biliary obstruction in patients with pancreatic carcinoma undergoing neoadjuvant chemoradiotherapy: A systematic review and meta-analysis

J Hepatobiliary Pancreat Sci. 2023 Apr;30(4):419-428. doi: 10.1002/jhbp.1240. Epub 2022 Oct 8.


Background: Preoperative biliary drainage (PBT) may be warranted in patients with borderline resectable or locally advanced pancreatic carcinoma before neoadjuvant therapy (NAT) to relieve obstructive jaundice. However, it is unclear if the use of self-expanding metal stents (SEMS) has any benefit over plastic stents in this setting.

Methods: We searched electronic databases from inception to February 11, 2022 to identify studies comparing SEMS and plastic stents for PBT in patients with pancreatic carcinoma undergoing NAT. Random effect models were used to determine pooled rates of recurrent biliary obstruction (RBO) and/or need for reintervention, stent-related complications and surgical outcome.

Results: A total of 10 studies (474 patients; metal group-37.1%) were included. Pooled risk ratio of RBO and/or need for reintervention was lower in the metal group (RR, 0.23 [95% CI: 0.11-0.45, I2 = 60%]). Pooled risks of stent occlusion (RR, 0.43 [95% CI: 0.24-0.80, I2 = 45%]) and stent-related cholangitis (RR, 0.37 [95% CI: 0.17-0.78, I2 = 1%]) were lower in the metal group. However, risks of stent-related cholecystitis (RR, 1.51 [95% CI: 0.36-6.41, I2 = 0%]) and pancreatitis (RR, 1.52 [95% CI: 0.07-31.84, I2 = 66%]) were higher in the metal group. The metal group was also associated with a reduced risk of delay in NAT (RR, 0.38 [95% CI: 0.18-0.80, I2 = 14%]). Pooled risk ratio of R0 resection and postoperative complications was equal amongst both groups.

Conclusion: Metal stents are associated with reduced risk of RBO and/or need for reintervention, reduced risk of stent occlusion and cholangitis as compared to plastic stents in patients with pancreatic carcinoma undergoing NAT.

Keywords: R0 resection; adenocarcinoma; neoadjuvant chemoradiotherapy; neoadjuvant chemotherapy; self-expandable metal stent.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Cholangitis* / etiology
  • Cholestasis* / etiology
  • Cholestasis* / surgery
  • Drainage / adverse effects
  • Humans
  • Metals
  • Neoadjuvant Therapy
  • Pancreatic Neoplasms* / surgery
  • Pancreatic Neoplasms* / therapy
  • Plastics
  • Self Expandable Metallic Stents* / adverse effects
  • Stents / adverse effects
  • Treatment Outcome


  • Metals
  • Plastics