Faculty of Medicine of the University of Coimbra (FMUC), Rua Larga 2; 3000-370 Coimbra, Portugal.
Faculty of Medicine of the University of Coimbra (FMUC), Rua Larga 2; 3000-370 Coimbra, Portugal; Department of Radiology, Centro Hospitalar e Universitário de Coimbra (CHUC) Praceta Mota Pinto, 3000-075 Coimbra, Portugal.
Eur J Radiol. 2020 Apr;125:108899. doi: 10.1016/j.ejrad.2020.108899. Epub 2020 Feb 13.
Benign biliary strictures arise mostly from iatrogenic injuries during surgical procedures and various inflammatory causes. Endoscopic placement of multiple plastic stents (MPS) is often regarded as the first-line therapy, albeit not without limitations. Biodegradable biliary stents (BDBS) present an alternative therapeutic option aimed at overcoming these shortcomings. The long-term stricture resolution rates between BDBS and MPS implantation in patients with benign biliary strictures (BBS) was therefore analyzed and compared, regardless of etiology.
Using predefined data fields, all articles published up to July 2018 were retrospectively selected and independently extracted by two authors and then excluded according to predefined criteria. Additional studies were identified by manually searching through article references. Any disagreements between authors on study selection were resolved by consensus.
3 studies for BDBS (n = 133) and 6 for MPS technique (n = 441) met the inclusion criteria. The overall success rate (defined as no stricture recurrence during follow-up) for BDBS implantation was 83 % (95 % [CI], 0.76-0.89), compared to 84 % (95 % [CI], 0.78-0.89) in the MPS group. Overall stent-related complication rates were reported to be slightly inferior in the BDBS group when compared to MPS, except for cholangitis (24.1 % vs. 6.1 %, respectively) and haemobilia (3% vs <1%, respectively). On average, BDBS required less interventions than MPS use (1 vs. 3, respectively).
The insertion of BDBS in the treatment of benign biliary strictures does not seem to be inferior to multiple plastic stents in resolving and maintaining long-term biliary duct patency, albeit exhibiting higher rates of post-procedural cholangitis.
良性胆道狭窄主要由手术过程中的医源性损伤和各种炎症原因引起。内镜下放置多个塑料支架（MPS）通常被认为是一线治疗方法，但并非没有局限性。可生物降解胆道支架（BDBS）提供了一种替代治疗选择，旨在克服这些缺点。因此，分析并比较了在良性胆道狭窄（BBS）患者中，BDBS 和 MPS 植入的长期狭窄缓解率，无论病因如何。
使用预定义的数据字段，回顾性选择截至 2018 年 7 月发表的所有文章，并由两位作者独立提取，然后根据预定义标准排除。通过手动搜索文章参考文献确定其他研究。作者对研究选择的任何分歧均通过协商解决。
3 项 BDBS 研究（n = 133）和 6 项 MPS 技术研究（n = 441）符合纳入标准。BDBS 植入的总体成功率（定义为随访期间无狭窄复发）为 83%（95%CI，0.76-0.89），而 MPS 组为 84%（95%CI，0.78-0.89）。与 MPS 相比，BDBS 组的支架相关并发症总体发生率略低，除胆管炎（分别为 24.1%和 6.1%）和血obilia（分别为 3%和<1%）外。平均而言，BDBS 需要的干预次数少于 MPS（分别为 1 次和 3 次）。
在治疗良性胆道狭窄方面，BDBS 的插入似乎并不逊于多个塑料支架，在解决和维持长期胆道通畅方面，但术后胆管炎的发生率更高。
