远端恶性胆道梗阻的原发性引流:一项比较网络荟萃分析。

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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引用次数: 0

摘要

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

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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来源期刊
Digestive and Liver Disease
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.
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