Common bile duct obstruction due to malignancy: Treatment with plastic versus metal stents

PURPOSE: To compare the clinical efficacy and treatment costs of plastic versus metal biliary stents. MATERIALS AND METHODS: In a randomized trial, 101 patients with malignant common bile duct obstruction underwent transhepatic stent implantation and were followed up until death. Patients were stratified into risk and nonrisk groups. Forty-nine patients received 12-F plastic stents, and 52 received expandable metal stents. Plastic endoprotheses were placed in a two-step procedure; metal stents, in a single procedure. Kaplan-Meier analyses were used to compare patient survival and stent patency rates. RESULTS: The 30-day mortality rate was significantly lower for metal stents (five of 52 [10%]) than plastic stents (12 of 49 [24%]; P=.05). The obstruction rate was 19% (10 of 52; median patency, 272 days) for metal stents and 27% for plastic stents (13 of 49; median patency, 96 days; P <.01). Median time until death or obstruction was longer for metal stents (122 vs 81 days; P <.01). Placement of metal stents was associated with shorter hospital stay (10 vs 21 days; P <.01) and lower cost ($7,542 vs $12,129; P<.01). CONCLUSION: Use of self-expanding metal stents appears to show substantial benefits for patients and to be cost-effective.