Division of Digestive Surgery, Department of Surgery, Sanglah General Hospital, Udayana University, Denpasar, Bali, Indonesia.
Asian Pac J Cancer Prev. 2023 Mar 1;24(3):791-800. doi: 10.31557/APJCP.2023.24.3.791.
To conduct a network meta-analysis (NMA) in comparing biliary stents types' outcomes and complications in unresectable MBO.
The study was conducted in accordance with the PRISMA and NMA extension . Comprehensive searches of the Cochrane Library, MEDLINE, and Scopus were done analyzing randomized controlled trials that included subjects with unresectable malignant biliary obstructions that underwent biliary stents placement from any approaches. The types of stents that included were full-covered metal (FMS), partially-covered metal (PMS), uncovered metal (UMS), plastic (PLS), Iodine-125 seeds strands (IRS), antireflux (ARS), and paclitaxel-coated (PXS) stents. The outcome parameters were clinical success, median patency duration, medial survival, and early 30-day mortality. The complications included were stent occlusion, stent migration, cholangitis, cholecystitis, pancreatitis, hemorrhage, and hemobilia. The NMA will be done based on Bayesian method, Markov Chain Monte Carlo algorithm, using BUGSnet package in R studio. Transivity was controlled by methods and consistency of the NMA will be fitted by deviance information criterion. Data analysis in NMA were presented in Sucra plot, league table, and forest plot.
Thirty-six RCTs were included with 3502 subjects. ARS had the best clinical success and longest median patency. However, it was associated with higher rate of complications. IRS had a good clinical success (RR 1.63; 95%CI 0.67-6.25), long median patency (MD 21.14; 95%CI -106.18 to 145.91), and high significant survival rate (MD 69.89; 95%CI 22 to 117.57) compared to others stents. It was associated unsignificant complications of cholecystitis, hemobilia, and hemorrhage.
Iodine-125 seeds strands had the promising good outcome and tolerated complications among others and should be considered as a standard stent to be used in unresectable malignant biliary obstructions.
比较不可切除性恶性胆道梗阻患者使用不同胆道支架的结局和并发症，进行网状 Meta 分析（NMA）。
本研究按照 PRISMA 和 NMA 扩展声明进行。系统检索 Cochrane 图书馆、MEDLINE 和 Scopus，纳入所有采用任何入路经胆道支架置入术治疗不可切除性恶性胆道梗阻的随机对照试验。支架类型包括全覆膜金属支架（FMS）、部分覆膜金属支架（PMS）、无覆膜金属支架（UMS）、塑料支架（PLS）、碘 125 放射性粒子支架（IRS）、抗反流支架（ARS）和紫杉醇涂层支架（PXS）。结局参数包括临床成功率、中位通畅时间、中位生存时间和早期 30 天死亡率。并发症包括支架堵塞、支架移位、胆管炎、胆囊炎、胰腺炎、出血和胆血征。NMA 将基于贝叶斯方法，马尔可夫链蒙特卡罗算法，使用 R 工作室中的 BUGSnet 包进行。采用一致性检验和处理传递性检验，Deviance Information Criterion（DIC）拟合一致性。网状 Meta 分析的数据以 Sucra 图、联赛表和森林图呈现。
纳入 36 项 RCT，共 3502 例患者。ARS 具有最佳的临床成功率和最长的中位通畅时间，但与较高的并发症发生率相关。IRS 具有良好的临床成功率（RR 1.63；95%CI 0.67-6.25）、较长的中位通畅时间（MD 21.14；95%CI -106.18 至 145.91）和高的生存率（MD 69.89；95%CI 22 至 117.57），与其他支架相比，胆囊炎、胆血征和出血等并发症发生率无显著差异。
碘 125 放射性粒子支架在不可切除性恶性胆道梗阻患者中具有较好的疗效和可耐受的并发症，可作为标准支架使用。
