Metallic versus plastic stents for the management of biliary obstruction: A GRADE-assessed systematic review and meta-analysis

Biliary obstruction can be managed with metallic stents (MS) or plastic stents (PS), but comparative evidence across benign and malignant conditions remains uncertain. We conducted a systematic review and meta-analysis comparing MS and PS.

PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched from inception to the search date. Randomized controlled trials and observational studies comparing MS with PS in patients with benign or malignant biliary obstruction were eligible. Primary analyses compared MS with PS across the overall eligible population, including both benign and malignant obstruction. Where sufficient outcome-specific data were available, subgroup analyses were performed according to disease etiology (benign vs malignant). Outcomes included functional success, adverse events, recurrent biliary obstruction (RBO), procedure time, and overall survival. Meta-analysis was performed with Hartung-Knapp sensitivity analyses.