Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Departments of Gastroenterology and Hepatology.
J Clin Gastroenterol. 2019 Jul;53(6):418-426. doi: 10.1097/MCG.0000000000001193.
Endoscopic stents are the first-line treatment in the management of benign biliary stricture (BBS) which include multiple plastic stents (MPSs), fully covered self-expandable metal stents (FCSEMS) including the conventional and modified ones (FCSEMS-C and FCSEMS-M) and biodegradable stents. However, different stents have their distinct advantages and disadvantages. We aim to conduct this systematic review to compare the efficacy of different stents in the management of BBS.
Several databases were searched from inception through March 2018. Studies including >10 patients with postoperative stricture treated with endoscopic stents were enrolled. Pooled odds ratio of outcomes were calculated to compare MPS with FCSEMS. Weighted pooled rates were calculated to show the efficacy of FCSEMS-M, FCSEMS-C, and MPS.
Twenty-two articles were reviewed including 4 randomized controlled studies, 4 cohort studies, and 14 case series studies. Comparing FCSEMS with MPS, the pooled odds ratio was 0.48 [95% confidence interval (CI): 0.22-1.05] (P=0.07) for stricture resolution, 0.3 (95% CI: 0.1-0.92) (P=0.03) for adverse event, 1.9 (95% CI: 0.3-12) (P=0.49) for stent migration, and 1.38 (95% CI: 0.36-5.3) (P=0.34) for stricture recurrence. The pooled rates for stricture recurrence of MPS, FCSEMS-C, and FCSEMS-M were 19%, 19%, and 7%, respectively. The pooled rates for stent migration were 4% of MPS, 25% of FCSEMS-C, and 3% of FCSEMS-M.
FCSEMS-M is more favorable in the management of BBS comparing with MPS or FCSEMS-C. The biodegradable stent may be a promising option but currently available data is insufficient to draw a firm conclusion.
内镜支架是良性胆道狭窄（BBS）管理的一线治疗方法，包括多种塑料支架（MPS）、全覆膜自膨式金属支架（FCSEMS），包括传统和改良支架（FCSEMS-C 和 FCSEMS-M）和生物可降解支架。然而，不同的支架有其独特的优点和缺点。我们旨在进行这项系统评价，以比较不同支架在 BBS 管理中的疗效。
从成立到 2018 年 3 月，我们检索了多个数据库。纳入>10 例术后狭窄患者，采用内镜支架治疗。计算汇总优势比来比较 MPS 与 FCSEMS。计算加权汇总率以显示 FCSEMS-M、FCSEMS-C 和 MPS 的疗效。
共评价了 22 篇文章，包括 4 项随机对照研究、4 项队列研究和 14 项病例系列研究。与 MPS 相比，FCSEMS 的汇总优势比为狭窄缓解（OR=0.48，95%CI：0.22-1.05，P=0.07）、不良事件（OR=0.3，95%CI：0.1-0.92，P=0.03）、支架迁移（OR=1.9，95%CI：0.3-12，P=0.49）和狭窄复发（OR=1.38，95%CI：0.36-5.3，P=0.34）。MPS、FCSEMS-C 和 FCSEMS-M 的狭窄复发率分别为 19%、19%和 7%。支架迁移率分别为 MPS 4%、FCSEMS-C 25%和 FCSEMS-M 3%。
与 MPS 或 FCSEMS-C 相比，FCSEMS-M 在 BBS 的治疗中更有优势。生物可降解支架可能是一种有前途的选择，但目前的数据不足以得出明确的结论。
