Endoscopic biliary stent placement is a minimally invasive intervention for patients
with biliary strictures. Stent patency and function time are crucial factors. Suprapapillary
versus transpapillary stent positioning may contribute to stent function time, so
a meta-analysis was performed in this comparison.A comprehensive literature search
was conducted in the CENTRAL, Embase, and MEDLINE databases to find data on suprapapillary
stent placement compared to the transpapillary method via endoscopic retrograde cholangiopancreatography
in cases of biliary stenosis of any etiology and any stent type until December 2020.
We carried out a meta-analysis focusing on the following outcomes: stent patency,
stent migration, rate of cholangitis and pancreatitis, and other reported complications.Three
prospective and ten retrospective studies involving 1028 patients were included. Suprapapillary
stent placement appeared to be superior to transpapillary stent positioning in patency
(weighted mean difference = 50.23 days, 95% CI: 8.56, 91.98; p = 0.0.018). In a subgroup
analysis of malignant indications, suprapapillary positioning showed a lower rate
of cholangitis (OR: 0.34, 95% CI: 0.13, 0.93; p = 0.036). Another subgroup analysis
investigating metal stents in a suprapapillary position resulted in a lower rate of
pancreatitis (OR: 0.16, 95% CI: 0.03, 0.95; p = 0.043) compared to transpapillary
stent placement. There was no difference in stent migration rates between the two
groups (OR: 0.67, 95% CI: 0.17, 2.72; p = 0.577).Based on our results, suprapapillary
biliary stenting has longer stent patency. Moreover, the stent migration rate did
not differ between the suprapapillary and transpapillary groups.
