Department of Internal Medicine, Banner University Medical Center, University of Arizona, Tucson, AZ.
Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA.
J Clin Gastroenterol. 2021 Mar 1;55(3):271-277. doi: 10.1097/MCG.0000000000001377.
GOALS/BACKGROUND: Patients with malignant biliary obstruction (MBO) often require transpapillary stenting for symptomatic relief and biliary decompression. Plastic stents and uncovered metal stents are now replaced by covered self-expanding metal stents (SEMS). However, stent occlusion from tumor overgrowth and chronic inflammation continues to be an issue. Drug-eluting stents (DES), through an antitumor paclitaxel membrane, have been used to combat this problem. The aim of this study was to conduct a meta-analysis comparing DES to SEMS in MBO.
Multiple databases were searched to identify studies that compared the clinical outcomes of SEMS and DES in patients with MBO. Random-effects model was used to calculate the pooled odds ratio and the pooled individual outcomes. Our primary goals were to assess the stent patency and overall survival in days. Secondary outcomes assessed the individual reported adverse events and/or complications.
Five studies including 348 patients (175 males and 173 females) were included. The pooled odds ratio of stent patency was 1.03 (95% confidence interval: 0.68-1.54, P=0.9) and overall survival was 1.16 (95% confidence interval: 0.63-2.11, P=0.6). The pooled rate of stent patency was 168.3 (95% 140.7-196.4) days for DES and 149.4 (117.6-181.2) days for SEMS. The pooled rate of overall survival was 267.2 (206.2-328.2) days for DES and 218.2 (148.5-287.8) days for SEMS.
On the basis of this meta-analysis, DES and SEMS seem to demonstrate comparable clinical outcomes in patients with malignant biliary strictures. Reported adverse events and/or complications were comparable as well.
目的/背景：恶性胆道梗阻（MBO）患者通常需要经皮经肝胆道支架置入术来缓解症状和进行胆道减压。目前，塑料支架和无覆膜金属支架已被覆膜自膨式金属支架（SEMS）取代。然而，肿瘤过度生长和慢性炎症导致的支架阻塞仍然是一个问题。载药支架（DES）通过载有抗肿瘤紫杉醇的膜来解决这个问题。本研究旨在进行一项荟萃分析，比较 MBO 患者中使用 DES 和 SEMS 的临床结果。
通过检索多个数据库，确定了比较 MBO 患者中 SEMS 和 DES 临床结果的研究。采用随机效应模型计算合并的优势比和个体结局。我们的主要目标是评估支架通畅率和总生存天数。次要结局评估个体报告的不良事件和/或并发症。
纳入了 5 项研究，共 348 例患者（175 例男性，173 例女性）。支架通畅率的合并优势比为 1.03（95%置信区间：0.68-1.54，P=0.9），总生存率为 1.16（95%置信区间：0.63-2.11，P=0.6）。DES 组的支架通畅率为 168.3（95%可信区间 140.7-196.4）天，SEMS 组为 149.4（117.6-181.2）天。DES 组的总生存率为 267.2（206.2-328.2）天，SEMS 组为 218.2（148.5-287.8）天。
根据这项荟萃分析，DES 和 SEMS 似乎在恶性胆道狭窄患者中显示出相似的临床结果。报告的不良事件和/或并发症也相似。
