Antireflux Metal Stent for Initial Treatment of Malignant Distal Biliary Obstruction

Table 3

Review of published articles on ARMS.

	Study design	No. of patients	Type of SEMS	Antireflux valve	TRBO	Complications	Cause of stent obstruction
							Sludge	Food impaction	Ingrowth	Overgrowth	Migration	Others
Hu et al. (2011) [12]	Prospective, single arm	23	UC 3, PC 20	Cross shaped	14 mo	Bleeding 1	0	0	1	2	3
Lee et al. (2013) [15]	Prospective, single arm	32	UC	S-type	14.4 mo	None	6	0	4	0	1
Kim et al. (2013) [14]	Prospective, single arm	5	PC	Wineglass shaped	64 d (4–235)	None	4	0	0	0	0
Hamada et al. (2014) [13]	Prospective, single arm	13	FC	Funnel shaped	Not reached	None	1	0	0	0	4	Unknown 1
Hu et al. (2014) [16]	RCT	ARMS 56	PC	Nipple shaped	13.0 ± 3.4 mo	Pancreatitis 1, cholangitis 1, cholecystitis 1, bleeding 1	2	0	3	1	5	Unknown 6
		SEMS 56	UC	—	10 ± 1.2 mo	Pancreatitis 2, cholecystitis 1, bleeding 1	2	0	14	5	1	Unknown 7
Hamada et al. (2015) [17]	Prospective, single arm	8	FC	Funnel shaped	71 d	Cholecystitis 1	2	0	0	0	1	Hemobilia 1
Lee et al. (2016) [32]	RCT	ARMS 39	PC	Windsock shaped	407 d	Pancreatitis 2, cholangitis 1	4	—	1	0	3	Valve dysfunction 2, hemobilia 1
		SEMS 38	PC	—	220 d	Pancreatitis 4, cholangitis 2	8	—	3	2	3
Hamada et al. (2016) [33]	Retrospective, single arm	20	FC	Funnel shaped	246 d	Pancreatitis 3, cholecystitis 1, liver abscess 1	3	2	0	0	2
Present study	Retrospective	ARMS 32	FC	Funnel shaped	180 d	Cholecystitis 1, liver failure 1	8	0	0	1	5
		SEMS 27	FC	—	137 d	Cholecystitis 2	3	4	0	1	3

TRBO: time to recurrent biliary obstruction; ARMS: antireflux metal stent; RCT: randomized controlled trial; SEMS: self-expandable metal stent; UC: uncovered; PC: partially covered; FC: fully covered.