Endoscopic Ultrasound‐Guided Hepaticogastrostomy With Plastic Stent Versus Metallic Stent for Malignant Biliary Obstruction: A Meta‐Analysis

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.