Zhou Haibin, Khizar Hayat, Ali Ashraf, Yang Jianfeng
Department of Gastroenterology, Affilated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, China.
Department of Surgery, The Fourth Affiliated Hospital, International Institute of Medicine, Zhejiang University School of Medicine, Hangzhou, China.
Therap Adv Gastroenterol. 2024 Aug 27;17:17562848241271962. doi: 10.1177/17562848241271962. eCollection 2024.
Stenting of the malignant hilar biliary obstruction (MHBO) area for bile drainage is challenging. Bilateral stenting techniques of stent-in-stent (SIS) and stent-by-stent (SBS) have shown promising results. This study evaluates the efficacy of different stenting methods for MHBO.
A meta-analysis was performed to determine the efficacy of SIS and SBS stenting strategies for MHBO.
Medical databases such as PubMed, Web of Science, Embase, and Scopus, were searched up to August 2023. We selected eligible studies reporting the data on technical and clinical success, adverse events, and incidence of re-obstruction (RO) of SBS and SIS groups in MHBO patients. We compared the outcomes of SBS and SIS groups.
A total of 9 studies comparing the data of 545 patients (268 in the SBS group and 277 in the SIS stenting group) were analyzed. There was no significant difference ( > 0.05) in the odds ratio (OR) of Re-obstruction (RO) 0.87 (95% confidence interval (95% CI) 0.6-1.25), technical success 0.58 (95% CI 0.16-2.11), clinical success 1.13 (95% CI 0.62-2.07), and adverse events 1.53 (95% CI 0.88-2.64). The mean difference in procedure time was -12.25 min (95% CI -18.39, -6.12), and the hazard ratio of stent patency was 1.22 (95% CI 1.01-1.47), favoring SBS, with high heterogeneity ( = 94%). There was no significant difference in HR for survival 1.05 (95% CI 0.95-1.16) with high heterogeneity ( = 84%).
Compared with SIS, SBS showed better stent patency with comparable technical and clinical success and adverse events.
The registration number for this study on PROSPERO is CRD42024523230.
对恶性肝门部胆管梗阻（MHBO）区域进行支架置入以引流胆汁具有挑战性。支架套叠（SIS）和逐一枚入支架（SBS）的双侧支架置入技术已显示出有前景的结果。本研究评估不同支架置入方法对MHBO的疗效。
进行一项荟萃分析以确定SIS和SBS支架置入策略对MHBO的疗效。
检索了截至2023年8月的PubMed、Web of Science、Embase和Scopus等医学数据库。我们选择了报告MHBO患者中SBS和SIS组的技术和临床成功率、不良事件以及再梗阻（RO）发生率数据的合格研究。我们比较了SBS组和SIS组的结果。
共分析了9项比较545例患者数据的研究（SBS组268例，SIS支架置入组277例）。再梗阻（RO）的优势比（OR）为0.87（95%置信区间（95%CI）0.6 - 1.25）、技术成功率为0.58（95%CI 0.16 - 2.11）、临床成功率为1.13（95%CI 0.62 - 2.07）以及不良事件为1.53（95%CI 0.88 - 2.64），均无显著差异（>0.05）。手术时间的平均差异为 - 12.25分钟（95%CI - 18.39， - 6.12），支架通畅率的风险比为1.22（95%CI 1.01 - 1.47），有利于SBS，但异质性高（I² = 94%）。生存的风险比为1.05（95%CI 0.95 - 1.16），异质性高（I² = 84%），无显著差异。
与SIS相比，SBS显示出更好的支架通畅率，技术和临床成功率以及不良事件相当。
PROSPERO注册：本研究在PROSPERO上的注册号为CRD42024523230。
