Yang Hui, Deng Jiangshan, Hu Yi, Hong Junbo
Department of Gastroenterology, First Affiliated Hospital of Nanchang University, 17 Yongwai Zheng Street, Nanchang, 330006, Jiangxi, People's Republic of China.
Surg Endosc. 2023 Nov;37(11):8178-8195. doi: 10.1007/s00464-023-10464-5. Epub 2023 Sep 26.
BACKGROUND/AIMS: Endoscopic biliary stenting is an essential treatment for malignant biliary obstruction (MBO). However, the optimal location for the placement of metal stents (MS) or plastic stents (PS) during the management of MBO, whether above (suprapapillary) or across (transpapillary) the sphincter of Oddi (SO), has not been thoroughly evaluated. This meta-analysis aims to compare the clinical outcomes associated with endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary stents placed above and across the SO in patients with MBO.
A comprehensive search of electronic databases was carried out to identify studies published from inception to April 2022. The clinical outcomes examined including stent patency, stent occlusion, and overall adverse events (AEs) such as cholangitis, post-ERCP pancreatitis (PEP), cholecystitis, stent migration, and bleeding. The selection of a random-effects model or fixed-effects model was based on the presence of heterogeneity.
A total of 12 articles involving 751 patients were analyzed. The findings showed that the suprapapillary approach had longer stent patency compared to the transpapillary approach (mean difference: 38.58; 95% confidence interval 16.02-61.14, P < 0.0001). Additionally, the suprapapillary approach was associated with a lower risk of stent occlusion and overall AEs (P = 0.04, P = 0.002, respectively), particularly in the incidence of PEP (P = 0.009). The incidence of cholangitis, cholecystitis, stent migration, and bleeding were similar between the suprapapillary and transpapillary approaches. The subgroup analyses indicated that suprapillary PS had a significant decrease in the incidence of stent occlusion and longer stent patency, while suprapillary MS had a significant decrease in the incidence of overall AEs and PEP than the transpapillary approach.
Compared with the transpapillary approach, the suprapapillary stent had superiority in longer stent patency, lower rates of stent occlusion and overall AEs, and notably, a lower incidence of PEP. The incidence of cholangitis, cholecystitis, stent migration, and bleeding were similar between the suprapapillary and transpapillary approaches. Further large-scale randomized controlled studies are needed to confirm our findings.
CRD42022336435.
背景/目的：内镜下胆道支架置入术是恶性胆管梗阻（MBO）的重要治疗方法。然而，在MBO的治疗过程中，金属支架（MS）或塑料支架（PS）放置在Oddi括约肌（SO）上方（乳头上方）还是穿过（经乳头）SO的最佳位置，尚未得到充分评估。本荟萃分析旨在比较内镜逆行胰胆管造影（ERCP）引导下，在MBO患者中，将胆道支架放置在SO上方和穿过SO的临床结局。
对电子数据库进行全面检索，以识别从数据库建立到2022年4月发表的研究。所检查的临床结局包括支架通畅性、支架闭塞以及总体不良事件（AE），如胆管炎、ERCP术后胰腺炎（PEP）、胆囊炎、支架移位和出血。根据异质性的存在选择随机效应模型或固定效应模型。
共分析了12篇涉及751例患者的文章。结果显示，与经乳头途径相比，乳头上方途径的支架通畅时间更长（平均差异：38.58；95%置信区间16.02 - 61.14，P < 0.0001）。此外，乳头上方途径与较低的支架闭塞风险和总体AE风险相关（分别为P = 0.04，P = 0.002），尤其是在PEP的发生率方面（P = 0.009）。乳头上方和经乳头途径之间胆管炎、胆囊炎、支架移位和出血的发生率相似。亚组分析表明，乳头上方PS的支架闭塞发生率显著降低，支架通畅时间更长，而乳头上方MS的总体AE和PEP发生率比经乳头途径显著降低。
与经乳头途径相比，乳头上方支架在更长的支架通畅时间、更低的支架闭塞率和总体AE发生率方面具有优势，特别是PEP的发生率更低。乳头上方和经乳头途径之间胆管炎、胆囊炎、支架移位和出血的发生率相似。需要进一步的大规模随机对照研究来证实我们的发现。
CRD42022336435。
