{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T21:15:26Z","timestamp":1788297326448,"version":"build-2803163510"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"1195","license":[{"start":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T00:00:00Z","timestamp":1732147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Stenting malignant hilar biliary obstruction (MHBO) is challenging due to its complex structure, and it is less effective than blockages in the distal bile duct area. Plastic stents (PSs) and metal stents (MSs) are commonly used for stenting MHBO. This study aims to compare the outcomes of PSs and MSs in MHBO patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a search of medical databases up to March 2024. Using a fixed-effect model, we analyzed the risk ratios (RRs) of the outcomes between the PS and MS groups. We calculated the RR for clinical and technical success, reinterventions, and adverse events, as well as the hazard ratio (HR) for survival and stent patency.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>This analysis includes five randomized controlled trials (RCTs) that met the inclusion criteria, comprising a total of 322 patients (156 in the PS group and 166 in the MS group). Significant differences (P\u2009&amp;lt;\u2009.05) in favor of the MS group were found in the reinterventions (RR 1.80, 95% CI 1.07\u20133.04), and stent patency (HR 0.54, 95% CI 0.32\u20130.90). There were no significant differences (P\u2009&amp;gt;\u20090.05) between the PS and MS groups regarding technical success (RR 1.01, 95% CI 0.94\u20131.09), clinical success (RR 0.86, 95% CI 0.69\u20131.07), overall survival (HR 0.71, 95% CI 0.47\u20131.05), stent migration (RR 0.69, 95% CI 0.08\u20136.02), stent occlusion (RR1.32, 95% CI 0.97\u20131.81), and adverse events (RR 0.80, 95% CI 0.53\u20131.20).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Both PS and MS are effective for managing MHBO, while MS offers greater efficacy in increased stent patency and lower reintervention rates.<\/jats:p>\n                  <jats:p>Key message What is already known on this topic Metal stents (MSs) and plastic stents (PSs) are used for palliative treatment of malignant hilar biliary obstruction (MHBO). MSs significantly reduced the need for reinterventions compared to PSs in patients with MHBO. What this study adds There were no significant differences between MSs and PSs in terms of technical success, clinical success, overall survival, stent migration, stent occlusion, or adverse events. How this study might affect research, practice, or policy The study\u2019s findings may prompt researchers to design more targeted studies to further investigate these specific outcomes in MHBO patients. The results encourage endoscopists to consider patient-specific factors, such as life expectancy and preference for minimizing recurrent procedures, when choosing between MSs and PSs for MHBO.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/postmj\/qgae165","type":"journal-article","created":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T23:33:27Z","timestamp":1732232007000},"page":"447-457","source":"Crossref","is-referenced-by-count":2,"title":["Evaluating safety and efficacy of plastic versus metal stenting in malignant hilar biliary obstruction: a systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.1093","volume":"101","author":[{"given":"Xinjie","family":"Luo","sequence":"first","affiliation":[{"name":"Department of surgery , Hangzhou First People's Hospital Tonglu Campus, 311500, Hangzhou,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhicheng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit , Hangzhou Geriatric Hospital, 50 Jingshen Road, 310022, Hangzhou,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamran","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Surgery , The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9736-1384","authenticated-orcid":false,"given":"Khizar","family":"Hayat","sequence":"additional","affiliation":[{"name":"Department of Surgery , The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,11,21]]},"reference":[{"key":"2025042208520906800_ref1","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1038\/nrgastro.2016.51","article-title":"Expert consensus document: cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European network for the study of cholangiocarcinoma (ENS-CCA)","volume":"13","author":"Banales","year":"2016","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"2025042208520906800_ref2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15245819","article-title":"Endoscopic treatment of malignant hilar biliary obstruction","volume":"15","author":"Pietrzak","year":"2023","journal-title":"Cancers"},{"key":"2025042208520906800_ref3","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1007\/s00423-023-02854-z","article-title":"Value of palliative surgery in perihilar cholangiocarcinoma","volume":"408","author":"Dondorf","year":"2023","journal-title":"Langenbeck's Arch Surg"},{"key":"2025042208520906800_ref4","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1111\/den.13680","article-title":"Comparison of endoscopic bilateral metal stent drainage with plastic stents in the palliation of unresectable hilar biliary malignant strictures: large multicenter study","volume":"33","author":"Xia","year":"2021","journal-title":"Dig Endosc"},{"key":"2025042208520906800_ref5","doi-asserted-by":"publisher","first-page":"347","DOI":"10.20524\/aog.2023.0810","article-title":"The role of endoscopy in malignant hilar obstruction","volume":"36","author":"Dhar","year":"2023","journal-title":"Ann Gastroenterol"},{"key":"2025042208520906800_ref6","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1007\/s00534-012-0508-8","article-title":"Metallic stents are more efficacious than plastic stents in unresectable malignant hilar biliary strictures: a randomized controlled trial","volume":"20","author":"Mukai","year":"2013","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"2025042208520906800_ref7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2022\/5741437","article-title":"The evaluation of clinical status of endoscopic retrograde cholangiography for the placement of metal and plastic stents in cholangiocarcinoma therapy","volume":"2022","author":"Gong","year":"2022","journal-title":"Comput Math Methods Med"},{"key":"2025042208520906800_ref8","doi-asserted-by":"publisher","first-page":"e000878","DOI":"10.1136\/bmjgast-2022-000878","article-title":"Factors predicting 30-day mortality after ERCP in patients with inoperable malignant hilar biliary obstruction: a single tertiary referral centre experience and systematic review","volume":"9","author":"On","year":"2022","journal-title":"BMJ Open Gastroenterol"},{"key":"2025042208520906800_ref9","doi-asserted-by":"publisher","first-page":"1871","DOI":"10.2169\/internalmedicine.6356-20","article-title":"Hilar malignant biliary obstruction treated with four metallic stents involving a new slim device","volume":"60","author":"Noguchi","year":"2021","journal-title":"Intern Med"},{"key":"2025042208520906800_ref10","doi-asserted-by":"publisher","first-page":"1235490","DOI":"10.3389\/fonc.2023.1235490","article-title":"Biliary drainage in malignant biliary obstruction: an umbrella review of randomized controlled trials","volume":"13","author":"Wang","year":"2023","journal-title":"Front Oncol"},{"key":"2025042208520906800_ref11","doi-asserted-by":"publisher","first-page":"174","DOI":"10.5009\/gnl220413","article-title":"Diagnosis and treatment of perihilar cholangiocarcinoma: a National Survey from the Korean Pancreatobiliary Association","volume":"18","author":"Cho","year":"2024","journal-title":"Gut Liver"},{"key":"2025042208520906800_ref12","doi-asserted-by":"publisher","first-page":"2213898","DOI":"10.1080\/07853890.2023.2213898","article-title":"Efficacy and safety of endoscopic drainage versus percutaneous drainage for pancreatic fluid collection; a systematic review and meta-analysis","volume":"55","author":"Khizar","year":"2023","journal-title":"Ann Med"},{"key":"2025042208520906800_ref13","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1007\/s10620-021-06906-6","article-title":"Long slimmer metal stent is feasible and effective for endoscopic dual stent-by-stent placement in malignant hilar biliary stricture","volume":"67","author":"Gao","year":"2022","journal-title":"Dig Dis Sci"},{"key":"2025042208520906800_ref14","doi-asserted-by":"publisher","first-page":"AB280","DOI":"10.1016\/j.gie.2022.04.733","article-title":"Efficacy and safety of radiofrequency ablation plus stent versus stent-alone treatments for malignant biliary strictures: a systematic review and meta-analysis","volume":"95","author":"Khizar","year":"2022","journal-title":"J Clin Gastroenterol"},{"key":"2025042208520906800_ref15","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1080\/07853890.2022.2164048","article-title":"Safety and efficacy of lumen-apposing metal stents and double-pigtail plastic stents for endoscopic ultrasound-guided drainage of walled-off necrosis; a systematic review and meta-analysis","volume":"55","author":"Khizar","year":"2023","journal-title":"Ann Med"},{"key":"2025042208520906800_ref16","doi-asserted-by":"publisher","first-page":"135","DOI":"10.5946\/ce.2022.150","article-title":"Optimal endoscopic drainage strategy for unresectable malignant hilar biliary obstruction","volume":"56","author":"Naitoh","year":"2023","journal-title":"Clin Endosc"},{"key":"2025042208520906800_ref17","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1016\/j.gie.2023.10.023","article-title":"Fully covered versus partially covered self-expandable metal stents for palliation of distal malignant biliary obstruction: a systematic review and meta-analysis","volume":"99","author":"Vanella","year":"2024","journal-title":"Gastrointest Endosc"},{"key":"2025042208520906800_ref18","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1016\/j.gie.2023.06.053","article-title":"Utility of bilateral intraductal plastic stent for malignant hilar biliary obstruction compared with bilateral self-expandable metal stent: a propensity score-matched cohort analysis","volume":"98","author":"Okuno","year":"2023","journal-title":"Gastrointest Endosc"},{"key":"2025042208520906800_ref19","doi-asserted-by":"publisher","first-page":"735","DOI":"10.5946\/ce.2020.003","article-title":"Inside plastic stents versus metal stents for treating Unresectable malignant Perihilar biliary obstructions: a retrospective comparative study","volume":"53","author":"Kanno","year":"2020","journal-title":"Clin Endosc"},{"key":"2025042208520906800_ref20","doi-asserted-by":"publisher","first-page":"922","DOI":"10.5009\/gnl20257","article-title":"The comparison of endoscopic biliary drainage in malignant hilar obstruction by cholangiocarcinoma: bilateral metal stents versus multiple plastic stents","volume":"15","author":"Kim","year":"2021","journal-title":"Gut Liver"},{"key":"2025042208520906800_ref21","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/j.gie.2023.03.007","article-title":"Suprapapillary placement of plastic versus metal stents for malignant biliary hilar obstructions: a multicenter, randomized trial","volume":"98","author":"Kanno","year":"2023","journal-title":"Gastrointest Endosc"},{"key":"2025042208520906800_ref22","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1111\/den.14669","article-title":"Side-by-side placement of fully covered metal stents versus conventional 7F plastic stents in malignant hilar biliary obstruction: prospective randomized controlled trial","volume":"36","author":"Paik","year":"2023","journal-title":"Dig Endosc"},{"key":"2025042208520906800_ref23","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1016\/j.clinre.2012.12.002","article-title":"Metal versus plastic stents for malignant biliary obstruction: an update meta-analysis","volume":"37","author":"Hong","year":"2013","journal-title":"Clin Res Hepatol Gastroenterol"},{"key":"2025042208520906800_ref24","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/j.gie.2015.03.1980","article-title":"Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis","volume":"82","author":"Sawas","year":"2015","journal-title":"Gastrointest Endosc"},{"key":"2025042208520906800_ref25","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ (Clinical research ed)"},{"key":"2025042208520906800_ref26","doi-asserted-by":"publisher","first-page":"2881","DOI":"10.1002\/sim.6556","article-title":"Meta-analysis of time-to-event outcomes from randomized trials using restricted mean survival time: application to individual participant data","volume":"34","author":"Wei","year":"2015","journal-title":"Stat Med"},{"key":"2025042208520906800_ref27","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat Med"},{"key":"2025042208520906800_ref28","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.jclinepi.2020.06.015","article-title":"The revised Cochrane risk of bias tool for randomized trials (RoB 2) showed low interrater reliability and challenges in its application","volume":"126","author":"Minozzi","year":"2020","journal-title":"J Clin Epidemiol"},{"key":"2025042208520906800_ref29","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/S0895-4356(99)00161-4","article-title":"Publication bias in meta-analysis: its causes and consequences","volume":"53","author":"Thornton","year":"2000","journal-title":"J Clin Epidemiol"},{"key":"2025042208520906800_ref30","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.jclinepi.2021.09.021","article-title":"Reliability of the revised Cochrane risk-of-bias tool for randomised trials (RoB2) improved with the use of implementation instruction","volume":"141","author":"Minozzi","year":"2022","journal-title":"J Clin Epidemiol"},{"key":"2025042208520906800_ref31","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.gie.2012.02.048","article-title":"Efficacy of metal and plastic stents in unresectable complex hilar cholangiocarcinoma: a randomized controlled trial","volume":"76","author":"Sangchan","year":"2012","journal-title":"Gastrointest Endosc"},{"key":"2025042208520906800_ref32","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1055\/s-2007-1010295","article-title":"Plastic endoprostheses versus metal stents in the palliative treatment of malignant hilar biliary obstruction. A prospective and randomized trial","volume":"25","author":"Wagner","year":"1993","journal-title":"Endoscopy"},{"key":"2025042208520906800_ref33","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/j.soc.2021.03.001","article-title":"Evaluation and Management of Malignant Biliary Obstruction","volume":"30","author":"Guardado","year":"2021","journal-title":"Surg Oncol Clin N Am"},{"key":"2025042208520906800_ref34","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1111\/den.13549","article-title":"Biliary stenting for hilar malignant biliary obstruction","volume":"32","author":"Lee","year":"2020","journal-title":"Dig Endosc"},{"key":"2025042208520906800_ref35","doi-asserted-by":"publisher","first-page":"791","DOI":"10.31557\/APJCP.2023.24.3.791","article-title":"A Bayesian network meta-analysis comparing biliary stent Types' outcome and complications in Unresectable malignant biliary obstructions","volume":"24","author":"Aryanti","year":"2023","journal-title":"Asian Pac J Cancer Prev"},{"key":"2025042208520906800_ref36","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1080\/17474124.2022.2085090","article-title":"Comparative efficacy and safety of local palliative therapeutics for unresectable malignant biliary obstruction: a Bayesian network meta-analysis","volume":"16","author":"Song","year":"2022","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"2025042208520906800_ref37","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1038\/ajg.2016.512","article-title":"Plastic vs.Self-expandable metal stents for palliation in malignant biliary obstruction: a series of meta-analyses","volume":"112","author":"Almadi","year":"2017","journal-title":"Am J Gastroenterol"},{"key":"2025042208520906800_ref38","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1111\/den.14776","article-title":"Evaluating optimal bilateral biliary stenting in endoscopic reintervention after initial plastic stent dysfunction for unresectable malignant hilar biliary obstruction: retrospective cross-sectional study","volume":"36","author":"Okuno","year":"2024","journal-title":"Dig Endosc"},{"key":"2025042208520906800_ref39","doi-asserted-by":"publisher","first-page":"1319","DOI":"10.1245\/s10434-023-14523-y","article-title":"Comparison between plastic and metallic biliary stent placement for preoperative patients with pancreatic head cancer: a systematic review and meta-analysis","volume":"31","author":"Endo","year":"2024","journal-title":"Ann Surg Oncol"},{"key":"2025042208520906800_ref40","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1002\/jhbp.1162","article-title":"Metal vs plastic stents for preoperative biliary drainage in patients with periampullary cancer: an updated systematic review and meta-analysis","volume":"30","author":"Watanabe","year":"2023","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"2025042208520906800_ref41","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1002\/jhbp.1240","article-title":"Outcome of metal vs plastic stents for biliary obstruction in patients with pancreatic carcinoma undergoing neoadjuvant chemoradiotherapy: a systematic review and meta-analysis","volume":"30","author":"Kumar","year":"2023","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"2025042208520906800_ref42","doi-asserted-by":"publisher","first-page":"8178","DOI":"10.1007\/s00464-023-10464-5","article-title":"Meta-analysis on clinical outcomes of suprapapillary versus transpapillary stent insertion in malignant biliary obstruction","volume":"37","author":"Yang","year":"2023","journal-title":"Surg Endosc"},{"key":"2025042208520906800_ref43","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1111\/den.12700","article-title":"Metal versus plastic stents for unresectable gallbladder cancer with hilar duct obstruction","volume":"29","author":"Gao","year":"2017","journal-title":"Dig Endosc"},{"key":"2025042208520906800_ref44","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1055\/a-0659-9864","article-title":"Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline - updated October 2017","volume":"50","author":"Dumonceau","year":"2018","journal-title":"Endoscopy"},{"key":"2025042208520906800_ref45","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1016\/j.gie.2020.12.035","article-title":"ASGE guideline on the role of endoscopy in the management of malignant hilar obstruction","volume":"94","author":"Qumseya","year":"2021","journal-title":"Gastrointest Endosc"},{"key":"2025042208520906800_ref46","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1111\/jgh.12128","article-title":"Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma","volume":"28","author":"Rerknimitr","year":"2013","journal-title":"J Gastroenterol Hepatol"}],"container-title":["Postgraduate Medical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/101\/1195\/447\/60780712\/qgae165.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/101\/1195\/447\/60780712\/qgae165.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T12:52:16Z","timestamp":1745326336000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/pmj\/article\/101\/1195\/447\/7906530"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,21]]},"references-count":46,"journal-issue":{"issue":"1195","published-online":{"date-parts":[[2024,11,21]]},"published-print":{"date-parts":[[2025,4,22]]}},"URL":"https:\/\/doi.org\/10.1093\/postmj\/qgae165","relation":{},"ISSN":["0032-5473","1469-0756"],"issn-type":[{"value":"0032-5473","type":"print"},{"value":"1469-0756","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,5]]},"published":{"date-parts":[[2024,11,21]]}}}