Division of Gastroenterology, Duke University Medical Center, Box 3913, Durham, NC 27710, USA.
Dig Dis Sci. 2012 Nov;57(11):2765-73. doi: 10.1007/s10620-012-2272-7. Epub 2012 Jun 26.
Covered or uncovered self expandable metallic stents (SEMS) placed in patients with malignant biliary obstruction can occlude in 19-40 %, but optimal management is unclear.
We sought to summarize current evidence regarding management of occluded SEMS in patients with malignant biliary obstruction.
Two investigators independently searched Pubmed, Embase, and Web of Science using pre-defined search criteria, and reviewed bibliographies of included studies. Data were independently abstracted by two investigators, and analyzed using RevMan. We compared strategies of second SEMS versus plastic stents with respect to the following outcomes: rate of second stent re-occlusion, duration of second stent patency, and survival.
Ten retrospective studies met inclusion criteria for the systematic review. Management options described were placement of an uncovered SEMS (n = 125), covered SEMS (n = 106), plastic stent (n = 135), percutaneous biliary drain (n = 7), mechanical cleaning (n = 18), or microwave coagulation (n = 7). Relative risk of re-occlusion was not significantly different in patients with second SEMS compared to plastic stents (RR 1.24, 95 % CI 0.92, 1.67, I(2) = 0, p 0.16). Duration of second stent patency was not significantly different between patients who received second SEMS versus plastic stents (weighted mean difference 0.46, 95 % CI -0.30, 1.23, I(2) = 83 %). Survival was not significantly different among patients who received plastic stents versus SEMS (weighted mean difference -1.13, 95 % CI -2.33, 0.07, I(2) 86 %, p = 0.07).
Among patients with malignant biliary obstruction and occluded SEMS, available evidence suggests a strategy of placing a plastic stent may be as effective as second SEMS. Limitations of these findings were that all studies were retrospective and heterogeneity between studies was detected for two of the outcomes.
在患有恶性胆道梗阻的患者中放置覆盖或未覆盖的自膨式金属支架（SEMS），其阻塞发生率为 19-40%，但最佳治疗方法尚不清楚。
我们旨在总结目前关于恶性胆道梗阻患者中阻塞性 SEMS 处理的证据。
两位研究者独立使用预定义的搜索标准在 Pubmed、Embase 和 Web of Science 上进行了搜索，并对纳入研究的参考文献进行了回顾。两位研究者独立提取数据，并使用 RevMan 进行分析。我们比较了第二代 SEMS 与塑料支架的策略，比较了以下结果：第二代支架再阻塞率、第二代支架通畅时间和生存率。
有 10 项回顾性研究符合系统综述的纳入标准。描述的处理方案包括放置未覆盖的 SEMS（n = 125）、覆盖的 SEMS（n = 106）、塑料支架（n = 135）、经皮胆道引流（n = 7）、机械清洁（n = 18）或微波凝固（n = 7）。与塑料支架相比，第二代 SEMS 患者的再阻塞风险无显著差异（RR 1.24，95%CI 0.92，1.67，I(2) = 0，p 0.16）。第二代支架通畅时间在接受第二代 SEMS 与塑料支架的患者之间无显著差异（加权均数差 0.46，95%CI -0.30，1.23，I(2) = 83%）。接受塑料支架与 SEMS 的患者的生存率无显著差异（加权均数差 -1.13，95%CI -2.33，0.07，I(2) 86%，p = 0.07）。
在患有恶性胆道梗阻和 SEMS 阻塞的患者中，现有证据表明，放置塑料支架的策略可能与第二代 SEMS 同样有效。这些发现的局限性在于所有研究均为回顾性研究，并且两个结局存在研究间异质性。
