Stent insertion for malignant hilar obstruction: a meta-analysis of percutaneous versus endoscopic approaches.

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY Przegla̜d Gastroenterologiczny Pub Date : 2024-01-01 Epub Date: 2023-07-27 DOI:10.5114/pg.2023.130124
Gang Wang, Yu-Fei Fu, Yan-Jin Yu
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Abstract

Introduction: In an effort to treat patients with malignant hilar obstruction (MHO), both percutaneous trans-hepatic biliary stenting (PTBS) and endoscopic biliary stenting (EBS) strategies have been implemented in the clinic, but the relative advantages of these techniques remain to be clarified.

Aim: This meta-analysis was designed to compare the relative clinical efficacy of PTBS and EBS in MHO patients.Material and methods: Relevant studies were identified through searches of the PubMed, Web of science, and Wanfang databases, and pooled analyses of these studies were then performed.

Results: In total, this meta-analysis included 11 studies enrolling 530 and 645 patients who underwent PTBS and EBS, respectively. Pooled rates of technical success in the PTBS patients were significantly higher than those for EBS patients (p < 0.0001). PTBS patients also exhibited significantly lower pooled cholangitis (p = 0.03) and pancreatitis (p < 0.0001) rates as compared to individuals in the EBS group. However, there were no significant differences in pooled clinical success rates (p = 0.45), haemorrhage rates (p = 0.57), stent patency (p = 0.96), or overall survival (p = 0.73) when comparing these groups. In a subgroup analysis, PTBS was not found to be superior to EBS as a treatment for Bismuth type III/IV MHO patients. However, PTBS did exhibit superior technical success and complication rates relative to EBS when treating hilar cholangiocarcinoma patients.

Conclusions: PTBS is superior to EBS with respect to many technical success and safety criteria when employed for the management of MHO patients.

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恶性肺门梗阻的支架置入:经皮与内镜入路的meta分析。
导言:为了治疗恶性肝门梗阻(MHO)患者,经皮经肝胆道支架植入术(PTBS)和内镜胆道支架植入术(EBS)策略已在临床实施,但这些技术的相对优势尚不清楚。目的:本荟萃分析旨在比较PTBS和EBS在MHO患者中的相对临床疗效。材料和方法:通过检索PubMed、Web of science和万方数据库,找到相关研究,并对这些研究进行汇总分析。结果:本荟萃分析共纳入11项研究,分别纳入530例PTBS和645例EBS患者。PTBS患者的总技术成功率显著高于EBS患者(p < 0.0001)。与EBS组相比,PTBS患者的合并胆管炎(p = 0.03)和胰腺炎(p < 0.0001)发生率也显著降低。然而,在临床总成功率(p = 0.45)、出血率(p = 0.57)、支架通畅(p = 0.96)或总生存率(p = 0.73)方面,两组比较无显著差异。在亚组分析中,未发现PTBS作为铋III/IV型MHO患者的治疗优于EBS。然而,在治疗肝门胆管癌患者时,PTBS确实表现出优于EBS的技术成功率和并发症发生率。结论:PTBS在许多技术成功和安全标准方面优于EBS,用于MHO患者的管理。
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来源期刊
Przegla̜d Gastroenterologiczny
Przegla̜d Gastroenterologiczny GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
2.20
自引率
7.70%
发文量
50
审稿时长
6-12 weeks
期刊介绍: Gastroenterology Review is a journal published each 2 months, aimed at gastroenterologists and general practitioners. Published under the patronage of Consultant in Gastroenterology and Polish Pancreatic Club.
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