Comparative Efficacy of Various Stents for Palliation in Patients with Malignant Extrahepatic Biliary Obstruction: A Systematic Review and Network Meta-Analysis

被引:12
作者
Park, Chan Hyuk [1 ]
Park, Se Woo [2 ]
Jung, Jang Han [2 ]
Jung, Eun Suk [2 ]
Kim, Jung Hee [2 ]
Park, Da Hae [2 ]
机构
[1] Hanyang Univ, Guri Hosp, Dept Internal Med, Coll Med, Guri 11923, South Korea
[2] Hallym Univ, Coll Med, Dongtan Sacred Heart Hosp, Div Gastroenterol,Dept Internal Med, Hwaseong 18450, South Korea
来源
JOURNAL OF PERSONALIZED MEDICINE | 2021年 / 11卷 / 02期
关键词
malignant biliary obstruction; stent; plastic stent; metal stent; recurrent biliary obstruction; EXPANDABLE METAL STENTS; BILE-DUCT OBSTRUCTION; RANDOMIZED-TRIAL; POLYETHYLENE STENTS; PLASTIC STENTS; NITINOL STENTS; COVERED METAL; STRICTURES; MULTICENTER; MIGRATION;
D O I
10.3390/jpm11020086
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Although many studies have investigated the efficacy of stent placement for patients with malignant extrahepatic biliary obstruction, the clinical outcomes and adverse events of biliary stenting have not been comprehensively evaluated. We searched all relevant randomized-controlled trials that evaluated the comparative efficacy of biliary stents, including the plastic stents, uncovered self-expandable metal stents (SEMSs), and covered SEMSs in patients with malignant extrahepatic biliary obstructions. Twenty-one studies with 2326 patients were included. Both uncovered and covered SEMSs had a lower risk of recurrent biliary obstruction (RBO) compared to plastic stents (risk ratio (RR) (95% confidence interval [CI]): uncovered vs. plastic, 0.46 (0.35-0.62); covered vs. plastic, 0.46 (0.34-0.62)). A comparison of the groups using SEMSs revealed that tumor ingrowth was common in the uncovered SEMS group, while stent migration, tumor overgrowth, and occlusion by sludge were common in the covered SEMS group; however, the overall risk of RBO did not differ between these groups (RR (95% CI): uncovered vs. covered: 1.02 (0.80-1.30)). Although the main causes of RBO vary across stents, RBO risk was similar between uncovered and covered SEMS groups. Both SEMSs have superior efficacy in terms of RBO compared to plastic stents.
引用
收藏
页码:1 / 20
页数:19
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