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Bilateral vs unilateral placement of metal stents for inoperable high-grade hilar biliary strictures: A systemic review and meta-analysis
Journal article   Open access   Peer reviewed

Bilateral vs unilateral placement of metal stents for inoperable high-grade hilar biliary strictures: A systemic review and meta-analysis

Munish Ashat, Sumant Arora, Jagpal S Klair, Christopher A Childs, Arvind R Murali and Frederick C Johlin
World journal of gastroenterology : WJG, Vol.25(34), pp.5210-5219
09/14/2019
DOI: 10.3748/wjg.v25.i34.5210
PMID: 31558868
url
https://doi.org/10.3748/wjg.v25.i34.5210View
Published (Version of record) Open Access

Abstract

Bilateral 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. To assess the efficacy and safety of bilateral unilateral biliary drainage in inoperable malignant hilar obstruction. 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. 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, = 0.009). There was no difference in the technical success rate (OR = 0.7, CI: 0.42-1.17, = 0.17), early complication rate (OR = 1.56, CI: 0.31-7.75, = 0.59), late complication rate (OR = 0.91, CI: 0.58-1.41, = 0.56) and stent malfunction (OR = 0.69, CI: 0.42-1.12, = 0.14) between bilateral and unilateral stenting for malignant hilar biliary strictures. 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.
 Bile Duct Neoplasms - surgery Postoperative Complications - etiology Constriction, Pathologic - etiology Drainage - adverse effects Klatskin Tumor - complications Humans Hepatic Duct, Common - pathology Treatment Outcome Postoperative Complications - epidemiology Cholestasis - surgery Constriction, Pathologic - surgery Hepatic Duct, Common - surgery Time Factors Cholestasis - etiology Drainage - instrumentation Reoperation - statistics & numerical data Drainage - methods Bile Duct Neoplasms - complications Stents - adverse effects Klatskin Tumor - surgery Palliative Care - methods

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