Biodegradable versus multiple plastic stent implantation in benign biliary strictures: A systematic review and meta-analysis

Purpose: Benign biliary strictures arise mostly from iatrogenic injuries during surgical procedures and various inflammatory causes. Endoscopic placement of multiple plastic stents (MPS) is often regarded as the first-line therapy, albeit not without limitations. Biodegradable biliary stents (BDBS) present an alternative therapeutic option aimed at overcoming these shortcomings. The long-term stricture resolution rates between BDBS and MPS implantation in patients with benign biliary strictures (BBS) was therefore analyzed and compared, regardless of etiology. Method: Using predefined data fields, all articles published up to July 2018 were retrospectively selected and independently extracted by two authors and then excluded according to predefined criteria. Additional studies were identified by manually searching through article references. Any disagreements between authors on study selection were resolved by consensus. Results: 3 studies for BDBS (n = 133) and 6 for MPS technique (n = 441) met the inclusion criteria. The overall success rate (defined as no stricture recurrence during follow-up) for BDBS implantation was 83 % (95 % [CI], 0.76-0.89), compared to 84 % (95 % [CI], 0.78-0.89) in the MPS group. Overall stent-related complication rates were reported to be slightly inferior in the BDBS group when compared to MPS, except for cholangitis (24.1 % vs. 6.1 %, respectively) and haemobilia (3% vs < 1%, respectively). On average, BDBS required less interventions than MPS use (1 vs. 3, respectively). Conclusions: The insertion of BDBS in the treatment of benign biliary strictures does not seem to be inferior to multiple plastic stents in resolving and maintaining long-term biliary duct patency, albeit exhibiting higher rates of post-procedural cholangitis.