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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Endoscopic retrograde cholangiopancreatography drainage for palliation of malignant hilar biliary obstruction — stent-in-stent or side-by-side? A systematic review and meta-analysis
Gabriel Mayo Vieira de Souza, Igor Braga Ribeiro, Mateus Pereira Funari, Diogo Turiani Hourneaux de Moura, Maria Vitória Cury Vieira Scatimburgo, João Remí de Freitas Júnior, Sergio A Sánchez-Luna, Renato Baracat, Eduardo Turiani Hourneaux de Moura, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
Gabriel Mayo Vieira de Souza, Igor Braga Ribeiro, Mateus Pereira Funari, Diogo Turiani Hourneaux de Moura, Maria Vitória Cury Vieira Scatimburgo, João Remí de Freitas Júnior, Renato Baracat, Eduardo Turiani Hourneaux de Moura, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura, Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
Sergio A Sánchez-Luna, Division of Gastroenterology, Hepatology and Nutrition, Center for Advanced Therapeutic Endoscopy, Allegheny Health Network, Pittsburgh, PA 15212, United States
Sergio A Sánchez-Luna, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Basil I. Hirschowitz Endoscopic Center of Excellence, Birmingham, AL 35294, United States
Author contributions: de Souza GMV contributed acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; Ribeiro IB, Funari MP, Scatimburgo MVCV and de Freitas Júnior JR contributed analysis and interpretation of data, revising the article; de Moura DTH contributed analysis of data, interpretation of data, drafting the article, revising the article, final approval; Sánchez-Luna SA contributed interpretation of data, drafting the article, revising the article, final approval; Baracat R contributed revising the article, drafting the article, final approval; de Moura ETH contributed revising the article, drafting the article, final approval; Bernardo WM contributed analysis and interpretation of data, drafting the article, final approval; de Moura EGH contributed analysis and interpretation of data, drafting the article, revising the article, final approval.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Igor Braga Ribeiro, MD, Doctor, Research Fellow, Surgeon, Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr Enéas de Carvalho Aguiar, 225, 6o andar, bloco 3, Cerqueira Cesar, São Paulo 05403-010, Brazil.
igorbraga1@gmail.com
Received: January 13, 2021
Peer-review started: January 13, 2021
First decision: February 24, 2021
Revised: March 11, 2021
Accepted: March 18, 2021
Article in press: March 18, 2021
Published online: May 27, 2021
Processing time: 127 Days and 12 Hours
BACKGROUND
Biliary drainage, either by the stent-in-stent (SIS) or side-by-side (SBS) technique, is often required when treating a malignant hilar biliary obstruction (MHBO). Both methods differ from each other and have distinct advantages.
AIM
To compare both techniques regarding their efficacy and safety in achieving drainage of MHBO.
METHODS
A comprehensive search of multiple electronic databases (MEDLINE, Embase, LILACS, BIREME, Cochrane) was conducted and grey literature from their inception until December 2020 with no restrictions regarding the year of publication or language, since there was at least an abstract in English. The included studies compared SIS and SBS techniques through endoscopic retrograde cholangiopancreatography. Outcomes analyzed included technical and clinical success, early and late adverse events (AEs), stent patency, reintervention, and procedure-related mortality.
RESULTS
Four cohort studies and one randomized controlled trial evaluating a total of 250 patients (127 in the SIS group and 123 in the SBS group) were included in this study. There were no statistically significant differences between the two groups concerning the evaluated outcomes, except for stent patency, which was higher in the SIS compared with the SBS technique [mean difference (d) = 33.31; 95% confidence interval: 9.73 to 56.90, I2 = 45%, P = 0.006].
CONCLUSION
The SIS method showed superior stent patency when compared to SBS for achieving bilateral drainage in MHBO. Both techniques are equivalent in terms of technical success, clinical success, rates of both early and late AEs, reintervention, and procedure-related mortality.
Core Tip: Biliary drainage is often required when treating a malignant hilar biliary obstruction. There are two types of drainage: Stent-in-stent (SIS) and side-by-side (SBS) techniques. Both of them differ from each other and have distinct advantages. This study aimed to compare both techniques regarding their efficacy and safety. Our systematic review and meta-analysis demonstrated no statistically significant differences between the SIS and SBS techniques; except for stent patency which was superior in the SIS technique. The choice of palliation for drainage must be guided by both local expertise and resource availability.
