Endoscopic Ultrasound‐Guided Hepaticogastrostomy With Plastic Stent Versus Metallic Stent for Malignant Biliary Obstruction: A Meta‐Analysis

ABSTRACT Objectives Endoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS) is an alternative procedure for malignant biliary obstruction after failure of endoscopic retrograde cholangiopancreatography. When performing EUS‐HGS, either plastic or metal stents are used, but selection often depends on the discretion of the endoscopist. We compared the efficacy and safety of plastic and metal stents during EUS‐HGS. Methods We performed a systematic meta‐analysis of all relevant articles listed by searching PubMed, Medline, and Web of Science databases. Random‐effects or fixed‐effects models were used to compare time to recurrent biliary obstruction (TRBO), clinical success rate, adverse event rate, rate of recurrent biliary obstruction, and re‐intervention success rate after EUS‐HGS with plastic and metal stents. Results This meta‐analysis included six eligible studies. The TRBO of the metal stent group was significantly longer than that of the plastic stent group (hazard ratio 1.83; 95% confidence interval [CI] 1.42–2.36). The total procedure‐related adverse event rate of the metal stent group was significantly higher than that of the plastic stent group (odds ratio [OR] 0.48; 95% CI 0.30–0.77). The recurrent biliary obstruction rate of the plastic stent group was significantly higher than that of the metal stent group (OR 1.75; 95% CI 1.06–2.88). No significant difference was found for the clinical success rate or re‐intervention success rate. Conclusion In this meta‐analysis, metal stents showed longer TRBO, lower recurrent biliary obstruction rate, and higher adverse event rate than plastic stents.