Malignant distal biliary obstruction: a systematic review and meta-analysis of endoscopic and surgical bypass results.

Abstract:

BACKGROUND:Surgical bypass and endoscopic stents are available for palliative bypass of malignant distal biliary obstruction. AIM:Comparison of reported outcomes in randomized controlled trials (RCTs) which included surgery, endoscopic plastic stents or endoscopic metal stents in palliative relief of malignant distal biliary obstruction. METHODS:Systematic review and meta-analysis of published literature and conference proceedings review to June 2006. RESULTS:We found 24 studies, containing 2436 patients, which met our inclusion criteria. Endoscopic stenting with plastic stents (three studies) is associated with a lower risk of complications (RR 0.60, 95% CI 0.45-0.81), but a higher risk of recurrent biliary obstruction (RR 18.59, 95% CI 5.33 -64.86) than traditional surgical bypass. Self-expanding metal stents (seven studies) are associated with a significantly reduced risk of recurrent biliary obstruction at 4 months (RR 0.44, 95% CI 0.3, 0.63), or prior to death or end of study (RR 0.52, 95% CI 0.39-0.69), but are not superior to plastic stents in terms of technical success, therapeutic success, mortality or complications. Cost-effectiveness outcomes were not suitable for meta-analysis. No other plastic stent designs have been demonstrated to be superior to polyethylene stents (12 studies). CONCLUSIONS:Endoscopic metal stents are the intervention of choice in patients with malignant distal biliary obstruction, producing similar outcomes to plastic stents, but with improved patency rates.

journal_name

Cancer Treat Rev

journal_title

Cancer treatment reviews

authors

Moss AC,Morris E,Leyden J,MacMathuna P

doi

10.1016/j.ctrv.2006.10.006

subject

Has Abstract

pub_date

2007-04-01 00:00:00

pages

213-21

issue

2

eissn

0305-7372

issn

1532-1967

pii

S0305-7372(06)00206-4

journal_volume

33

pub_type

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