Papaefthymiou Apostolis, Ramai Daryl, Maida Marcello, Tziatzios Georgios, Facciorusso Antonio, Triantafyllou Konstantinos, Arvanitakis Marianna, Johnson Gavin, Phillpotts Simon, Webster George, Gkolfakis Paraskevas
Pancreatobiliary Unit, University College London Hospitals, London, United Kingdom (Apostolis Papaefthymiou, Gavin Johnson, Simon Phillpotts, George Webster).
Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA (Daryl Ramai).
Ann Gastroenterol. 2024 Jul-Aug;37(4):485-492. doi: 10.20524/aog.2024.0886. Epub 2024 Jun 14.
Stent selection in the endoscopic management of post-liver-transplant anastomotic biliary strictures remains controversial. This systematic review and meta-analysis aimed to evaluate the potential differences between available stents.
MEDLINE, Cochrane, and Scopus databases were searched until April 2023 for comparative studies evaluating stricture management using multiple plastic stents (MPS) and self-expandable metal stents (SEMS), including fully-covered (FC)- and intraductal (ID)-SEMS. The primary outcome was stricture resolution, while secondary outcomes included stricture recurrence, stent migration and adverse events. Meta-analyses were based on a random-effects model and the results were reported as odds ratios (OR) with 95% confidence intervals (CI). Subgroup analyses by type of metal stent and a cost-effectiveness analysis were also performed.
Nine studies (687 patients) were finally included. Considering stricture resolution, SEMS and MPS did not differ significantly (OR 0.99, 95%CI 0.48-2.01; =35%). Stricture recurrence, migration rates and adverse events were also comparable (OR 1.71, 95%CI 0.87-3.38; =55%, OR 0.73, 95%CI 0.32-1.68; =56%, and OR 1.47, 95%CI 0.89-2.43; =24%, respectively). In the subgroup analysis, stricture resolution and recurrence rates did not differ for ID-SEMS vs. MPS or FC-SEMS vs. MPS. Migration rates were lower for ID-SEMS compared to MPS (OR 0.28, 95%CI 0.11-0.70; =0%), and complication rates were higher after FC-SEMS compared to MPS (OR 1.76, 95%CI 1.06-2.93; =0%). Finally, ID-SEMS were the most cost-effective approach, with the lowest incremental cost-effectiveness ratio: 3447.6 £/QALY.
Stent type did not affect stricture resolution and recurrence; however, ID-SEMS placement was the most cost-effective approach compared to the alternatives.
肝移植术后吻合口胆管狭窄的内镜治疗中支架的选择仍存在争议。本系统评价和荟萃分析旨在评估现有支架之间的潜在差异。
检索MEDLINE、Cochrane和Scopus数据库至2023年4月，以查找评估使用多种塑料支架（MPS）和自膨式金属支架（SEMS，包括全覆膜（FC）-SEMS和胆管内（ID）-SEMS）进行狭窄管理的比较研究。主要结局为狭窄缓解，次要结局包括狭窄复发、支架移位和不良事件。荟萃分析基于随机效应模型，结果以比值比（OR）及95%置信区间（CI）报告。还进行了按金属支架类型的亚组分析和成本效益分析。
最终纳入9项研究（687例患者）。在狭窄缓解方面，SEMS和MPS无显著差异（OR 0.99，95%CI 0.48-2.01；I² =35%）。狭窄复发率、移位率和不良事件也相当（OR分别为1.71，95%CI 0.87-3.38；I² =55%，OR 0.73，95%CI 0.32-1.68；I² =56%，以及OR 1.47，95%CI 0.89-2.43；I² =24%）。在亚组分析中，ID-SEMS与MPS或FC-SEMS与MPS之间在狭窄缓解和复发率方面无差异。与MPS相比，ID-SEMS的移位率较低（OR 0.28，95%CI 0.11-0.70；I² =0%），与MPS相比，FC-SEMS后的并发症发生率较高（OR 1.76，95%CI 1.06-2.93；I² =0%）。最后，ID-SEMS是最具成本效益的方法，增量成本效益比最低：3447.6英镑/质量调整生命年。
支架类型不影响狭窄缓解和复发；然而，与其他方法相比，放置ID-SEMS是最具成本效益的方法。
