Primary drainage of distal malignant biliary obstruction: A comparative network meta-analysis.

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive and Liver Disease Pub Date : 2024-09-13 DOI:10.1016/j.dld.2024.08.053

Gaetano Lauri, Livia Archibugi, Paolo Giorgio Arcidiacono, Alessandro Repici, Cesare Hassan, Gabriele Capurso, Antonio Facciorusso

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Abstract

Background: The effectiveness of various primary upfront drainage techniques for distal malignant biliary obstructions (dMBO) is not well-established.

Objective: To compare the technical and clinical success rates and adverse event (AE) rates of various primary drainage techniques.

Methods: We systematically reviewed RCTs comparing the technical and clinical success and AE rates of EUS-choledochoduodenostomy (CDS) with lumen-apposing metal stent (LAMS), EUS-CDS with self-expandable metal stents (SEMS), EUS-hepaticogastrostomy (HGS), ERCP, and PTBD performed upfront.

Results: Six RCTs involving 583 patients were analyzed. EUS-CDS with LAMS showed significantly higher technical success compared to EUS-CDS with SEMS (RR 1.21, 95 % CI 1.07-1.37) and ERCP (RR 1.17, 95 % CI 1.07-1.28). EUS-CDS with LAMS had the highest rank in technical success (SUCRA = 0.86). The clinical success rate was also higher with EUS-CDS with LAMS than with ERCP (RR 1.12, 1.01-1.25). PTBD was the worst ranked procedure for safety (SUCRA score = 0.18), while EUS-CDS with LAMS was the top procedure for procedural time (SUCRA score = 0.83).

Conclusion: EUS-CDS with LAMS has the highest technical and clinical success rates and is significantly superior to ERCP as the upfront technique for dMBO treatment. PTBD should be abandoned as first-line treatment due to the poor safety profile.

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远端恶性胆道梗阻的原发性引流：一项比较网络荟萃分析。

背景：针对远端恶性胆道梗阻（dMBO）的各种初次前置引流技术的有效性尚未得到充分证实：比较各种前置引流技术的技术和临床成功率以及不良事件（AE）发生率：方法：我们系统回顾了比较 EUS-胆总管十二指肠造口术（CDS）与腔内金属支架（LAMS）、EUS-CDS 与自膨胀金属支架（SEMS）、EUS-肝胃造口术（HGS）、ERCP 和 PTBD 的技术、临床成功率和 AE 率的 RCT：对涉及 583 名患者的六项研究进行了分析。与 EUS-CDS 配合 SEMS（RR 1.21，95 % CI 1.07-1.37）和 ERCP（RR 1.17，95 % CI 1.07-1.28）相比，EUS-CDS 配合 LAMS 的技术成功率明显更高。使用 LAMS 的 EUS-CDS 技术成功率最高（SUCRA = 0.86）。采用 LAMS 的 EUS-CDS 临床成功率也高于 ERCP（RR 1.12，1.01-1.25）。PTBD 是安全性排名最差的手术（SUCRA 评分 = 0.18），而 EUS-CDS 配 LAMS 是手术时间排名第一的手术（SUCRA 评分 = 0.83）：结论：采用 LAMS 的 EUS-CDS 技术和临床成功率最高，作为 dMBO 治疗的先期技术明显优于 ERCP。由于安全性较差，应放弃将 PTBD 作为一线治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.