A stent with radioactive seed strand insertion for inoperable malignant biliary obstruction: A meta-analysis

PURPOSE: The purpose of the study was to assess the relative clinical effectiveness of stent insertion with or without radioactive seed strand (RSS) insertion in patients suffering from malignant biliary obstruction (MBO). METHODS AND MATERIALS: Relevant articles published as of November 2020 in the Embase, PubMed, and Cochrane Library databases were identified and analyzed. Primary study endpoints for this meta-analysis were stent dysfunction, stent patency, and overall survival (OS), whereas secondary endpoints were rates of clinical success and complications. RevMan v5.3 was used to perform all meta-analyses. RESULTS: In total, there were nine studies incorporating 643 patients (280 and 363 who underwent stent insertion with and without RSS, respectively). No differences were observed between these groups with respect to pooled rates of clinical success ( p = 0.25), stent dysfunction ( p = 0.47), cholangitis ( p = 0.97), cholecystitis ( p = 0.95), or pancreatitis ( p = 0.66). However, stent patency duration ( p < 0.00001) and patients' OS ( p < 0.00001) were significantly increased in patients in the stent + RSS group. No heterogeneity was detected for any of these endpoints, nor did funnel plots yield any publication bias. A subgroup analysis of patients with hilar MBO similarly exhibited stent + RSS insertion to be associated with longer stent patency and OS as compared with stent insertion alone. CONCLUSIONS: These findings showed that relative to stent insertion, stent + RSS insertion is associated with longer OS and stent patency in patients with inoperable MBO. (c) 2021 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.