Bilateral vs unilateral placement of metal stents for inoperable high-grade hilar biliary strictures: A systemic review and meta-analysis
| Autor: | Frederick C. Johlin, Munish Ashat, Arvind R. Murali, Sumant Arora, Christopher A Childs, Jagpal Singh Klair |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Reoperation
medicine.medical_specialty Time Factors medicine.medical_treatment Technical success rate Hepatic Duct Common Constriction Pathologic Biliary Stenting law.invention 03 medical and health sciences 0302 clinical medicine Postoperative Complications Randomized controlled trial law medicine Humans Metal stent Re-intervention rate Cholestasis Hilar biliary stricture business.industry Palliative Care Gastroenterology Stent Retrospective cohort study General Medicine Odds ratio Confidence interval Early complication Surgery Treatment Outcome Bile Duct Neoplasms 030220 oncology & carcinogenesis Meta-analysis Drainage 030211 gastroenterology & hepatology Stents business Meta-Analysis Klatskin Tumor |
| Zdroj: | World Journal of Gastroenterology |
| ISSN: | 2219-2840 1007-9327 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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