Comparison of covered and uncovered self-expandable stents in the treatment of malignant biliary obstruction

espanolAntecedentes y objetivo: el drenaje con protesis metalicas es el tratamiento de eleccion de la ictericia obstructiva maligna. El exito tecnico y el exito clinico con las protesis metalicas se logran en mas del 90% y el 80% de los casos, respectivamente. Existen protesis metalicas autoexpandibles cubiertas con el proposito de prolongar su permeabilidad. El objetivo del estudio fue describir los resultados de utilizar protesis metalicas autoexpandibles totalmente cubiertas y protesis metalicas autoexpandibles no cubiertas en la paliacion de la obstruccion biliar maligna. Pacientes y metodos: de manera retrospectiva fueron incluidos 68 pacientes con ictericia obstructiva maligna secundaria a patologia pancreatobiliar o metastasica no candidatos a cirugia. Se formaron dos grupos: grupo A (protesis metalicas autoexpandibles cubiertas) (n = 22) y grupo B (protesis metalicas autoexpandibles no cubiertas) (n = 46). Resultados: en ambos grupos se observo la disminucion en los valores sericos de bilirrubina total, bilirrubina directa, fosfatasa alcalina y gammaglutamiltransferasa. Sin embargo, no hubo una diferencia estadisticamente significativa (p = 0,800; p = 0,190; p = 0,743; p = 0,521). La migracion fue mayor con las protesis cubiertas, pero no tuvo significacion estadistica (p = 0,101). La obstruccion fue mayor en el grupo con protesis no cubiertas y tampoco fue estadisticamente significativa (p = 0,476). Conclusion: no hay diferencia entre utilizar protesis autoexpandibles totalmente cubiertas y protesis autoexpandibles no cubiertas con respecto al exito tecnico, exito clinico, y complicaciones cuando se utilizan para paliar la ictericia obstructiva maligna. EnglishBackground and objective: Drainage with metallic stents is the treatment of choice in malignant obstructive jaundice. Technical and clinical success with metallic stents is obtained in over 90% and 80% of cases, respectively. There are self-expandable metallic stents designed to increase permeability. The aim of this study was to describe the results obtained with totally covered self-expandable and uncovered self-expandable metallic stents in the palliative treatment of malignant biliary obstruction. Patients and methods: Sixty eight patients with malignant obstructive jaundice secondary to pancreatobiliary or metastatic disease not amenable to surgery were retrospectively included. Two groups were created: group A (covered self-expandable metallic stents) (n = 22) and group B (uncovered self-expandable metallic stents) (n = 46). Results: Serum total bilirubin, direct bilirubin, alkaline phosphatase and gamma glutamyl transferase levels decreased in both groups and no statistically significant difference was detected (p = 0.800, p = 0.190, p = 0.743, p = 0.521). Migration was greater with covered stents but it was not statistically significant either (p = 0.101). Obstruction was greater in the group with uncovered stents but it was not statistically significant either (p = 0.476). Conclusion: There are no differences when using covered self-expandable stents or uncovered self-expandable stents in terms of technical and clinical success or complications in the palliative treatment of malignant obstructive jaundice.