Efficacy of Plastic Versus Metal Biliary Stents on Bilirubin Regression in Malignant Obstructive Jaundice: A Retrospective Analysis

Background: Malignant obstruction of the biliary tree often confers a worse outcome and poorer quality of life due to hyperbilirubinemia reducing the efficacy of chemotherapy and causing uncomfortable symptoms, respectively. Though we understand the difference in length of patency between plastic stents (PS) and self-expanding metal stents (SEMS), we lack evidence that one has increased efficacy in bilirubin regression over the other.

Methods: We retrospectively compared 211 patients with either PS or SEMS placement for hyperbilirubinemia secondary to malignant biliary obstruction to analyze each stent’s impact on rate of bilirubin regression.

Results: We found no difference in rate of bilirubin regression between PS and SEMS at 2 weeks, 4 weeks, and 3 months when analyzing all interventions, however there was a statistically significant faster rate of regression in metal stents in initial intervention at 2 weeks, but no difference at 4 weeks or 3 months. There was a significant decrease in bilirubin at each level of obstruction with both types of stent placement.

Conclusion: Both PS and SEMS placement are effective in palliation of malignant hyperbilirubinemia regardless of the level of biliary obstruction. Though SEMS have a longer duration of patency compared to PS, it does not confer a faster level of bilirubin regression over the long term.