Bilateral vs unilateral placement of metal stents for inoperable high-grade hilar biliary strictures: A systemic review and meta-analysis

被引:37
作者
Ashat, Munish [1 ]
Arora, Sumant [1 ]
Klair, Jagpal S. [2 ]
Childs, Christopher A. [3 ]
Murali, Arvind R. [1 ]
Johlin, Frederick C. [1 ]
机构
[1] Univ Iowa Hosp & Clin, Div Gastroenterol & Hepatol, Iowa City, IA 52242 USA
[2] Sect Gastroenterol, Virginia Mason 1100 Ninth Ave, Seattle, WA 98111 USA
[3] Univ Iowa Hosp & Clin, Hardin Lib, Iowa City, IA 52242 USA
关键词
Metal stent; Hilar biliary stricture; Re-intervention rate; Technical success rate; OBSTRUCTION; MANAGEMENT; PALLIATION; INSERTION; DRAINAGE; EFFICACY; QUALITY;
D O I
10.3748/wjg.v25.i34.5210
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BACKGROUND Bilateral vs unilateral biliary stenting is used for palliation in malignant biliary obstruction. No clear data is available to compare the efficacy and safety of bilateral biliary stenting over unilateral stenting. AIM To assess the efficacy and safety of bilateral vs unilateral biliary drainage in inoperable malignant hilar obstruction. METHODS PubMed, Embase, Scopus, and Cochrane databases, as well as secondary sources (bibliographic review of selected articles and major GI proceedings), were searched through January 2019. The primary outcome was the re-intervention rate. Secondary outcomes were a technical success, early and late complications, and stent malfunction rate. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated for each outcome. RESULTS A total of 9 studies were included (2 prospective Randomized Controlled Study, 5 retrospective studies, and 2 abstracts), involving 782 patients with malignant hilar obstruction. Bilateral stenting had significantly lower re-intervention rate compared with unilateral drainage (OR = 0.59, 95% CI: 0.40-0.87, P = 0.009). There was no difference in the technical success rate (OR = 0.7, CI: 0.42-1.17, P = 0.17), early complication rate (OR = 1.56, CI: 0.31-7.75, P = 0.59), late complication rate (OR = 0.91, CI: 0.58-1.41, P = 0.56) and stent malfunction (OR = 0.69, CI: 0.42-1.12, P = 0.14) between bilateral and unilateral stenting for malignant hilar biliary strictures. CONCLUSION Bilateral biliary drainage had a lower re-intervention rate as compared to unilateral drainage for high grade inoperable malignant biliary strictures, with no significant difference in technical success, and early or late complication rates.
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收藏
页码:5210 / 5219
页数:10
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