Post written by Sunguk Jang, MD, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.

This article compares the efficacy and safety of covered versus uncovered metallic biliary stents in patients with malignant biliary strictures. There remains a controversy over the increased risk of cholecystitis after the placement of covered metallic stents for malignant biliary strictures. Studies thus far have produced mixed results and clarification is needed from a large study.

Our study showed that the rate of post-ERCP cholecystitis was significantly higher among patients treated with covered metal stents versus those that were treated with uncovered metal stents. We hypothesized that flow of bile from the gallbladder is hampered significantly when the cystic duct orifice is occluded with the covered portion of a metal stent, whereas uncovered stents still permit the flow of bile via its interstices. Given that there is no benefit in stent patency duration with covered stents compared to that of uncovered stents, we concluded that uncovered metal stents should be given consideration as a preferred choice in patients with malignant strictures and gallbladder in situ. A prospective study with cost analysis regarding this issue would be a logical next step.

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