Comparison Of The Application Of Fully Covered Self-expandable Metal Stent And Multiple Plastic Stents In Benign Biliary Strictures

Objective To compare the effectiveness,safety and cost-effectiveness of a fully covered self-expandable metal stent(FCSEMS)and multiple plastic stents(MPS)in the treatment of benign biliary strictures(BBS).Methods To retrospectively analyze the clinical data of 107 patients with benign biliary structures who were implanted with FCSEMS or MPS through ERCP in the Department of Gastroenterology,Hangzhou First People’s Hospital from January 2013 to December 2018,and evaluate the stenosis remission rate and endoscopic-related complications Incidence rate,stenosis recurrence rate and stent migration rate during follow-up.The follow-up end point was March 2020 or recurrence of benign bile duct stenosis.Failure to follow up after stent placement was defined as loss to follow-up.Results The 54 patients in the FCSEMS group and 53 patients in the MPS group who met the inclusion criteria underwent 54 and 109 endoscopic stent placements,respectively.There was no significant difference in structure remission rates(87.0%vs 83.0%,P=0.560),complication rates(14.8%vs 11.9%,P=0.604),and structure recurrence rates(14.6%vs 23.5%,P=0.325).There is a significant difference in the migration rates of the stent between the two groups,all of which migrate to the distal bile duct.The cost-benefit analysis showed that the median number of ERCP interventions in the two groups were 2 and 3 times(P<0.001),and the median hospital stay was 6 days and 9 days(P=0.009),respectively.There were statistical differences.The median hospitalization expenses of the two groups were 44646 yuan and 51355 yuan(P=0.501),respectively,and there was no statistical difference.Conclusion The effectiveness,safety and treatment cost of inserting FCSEMS under endoscopy for the treatment of benign biliary strictures are similar to those of MPS,but the treatment cycle is reduced.Even with a certain migration rate,it can still be a first-line treatment.