Comparison of Stent Patency, Biochemical and Clinical Improvement in Plastic Versus Metallic Biliary Stent for Palliation in Malignant Biliary Obstruction in a Developing Country Tertiary Hospital

Abstract

Objective: To compare stent patency, biochemical, and clinical outcomes between partially covered self-expandable metal stents (SEMS) and plastic stents (PS) in patients with malignant biliary obstruction.

Methodology: A prospective observational study was conducted at Faisalabad Teaching Hospital from January to June 2024. Sixty patients with malignant biliary obstruction confirmed by imaging and elevated bilirubin (?1.75 mg/dL) were included. Patients were allocated to PS or SEMS groups based on clinical judgment. ERCP was performed by experienced gastroenterologists. Outcomes assessed included stent patency, biochemical improvement, complications, and reintervention rates. Data were analyzed using SPSS v20 with t-test and Chi-square; p < 0.05 was considered significant.

Results: The PS group included 30 patients (60% male; mean age 57.9 ± 7.9 years), and the SEMS group included 30 patients (66.7% male; mean age 55.7 ± 6.9 years). Pancreatic cancer was the most frequent diagnosis, followed by gallbladder cancer and cholangiocarcinoma. Post-procedural cholangitis was significantly higher in the PS group (80.0%) compared to SEMS (43.3%; p = 0.003). Stent dysfunction occurred in 63.3% of PS versus 33.3% of SEMS (p = 0.021). Mean stent patency was significantly longer with SEMS (190.5 ± 98.7 days) than PS (128.7 ± 54.3 days; p = 0.004). Biochemical improvement and symptom relief were superior in the SEMS group, with fewer reinterventions and shorter hospital stays.

Conclusion: SEMS demonstrated better patency, lower complication rates, and improved clinical outcomes compared to PS, supporting their use as a more effective palliative option in malignant biliary obstruction, especially for patients with longer life expectancy.