Published online May 27, 2021. doi: 10.4254/wjh.v13.i5.595
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
Patients with malignant hilar biliary obstruction (MHBO) benefit from bilateral palliative endoscopic drainage. However, there is no consensus on which is the optimal technique for placing a metal stent: Stent-in-stent (SIS) or side-by-side (SBS).
Many patients undergo palliative endoscopic retrograde cholangiopancreatography (ERCP) drainage, due to the advanced stage of the disease at the time of diagnosis, unresectable in most cases. However, choosing the best management for drainage can be a real technical challenge. Therefore, we aimed to compare both drainage techniques in an attempt to identify the optimal approach.
To perform a systematic review and meta-analysis of available studies that compare SIS and SBS deployment in patients with MHBO undergoing ERCP drainage.
The systematic review and meta-analysis followed the PRISMA Guidelines. Electronic searches were performed in MEDLINE, Embase, Cochrane, LILACS, and BIREME databases, and the grey literature. Comparative cohorts and randomized controlled trials (RCTs) were included. Studied outcomes were technical and clinical success, early and late adverse events (AEs), stent patency, reintervention, and procedure-related mortality.
Four comparative cohorts and one RCT were included in the final analysis with a total of 250 patients, of whom 127 belonged to the SIS group and 123 to the SBS group. Stent patency was significantly higher in the SIS group. Procedure-related mortality was similar in both groups, and no significant differences were found in the rates of technical success, clinical success, early AEs, late AEs, and reintervention.
There was no difference between the groups concerning technical and clinical success, early and late AEs, reintervention, and procedure-related mortality. However, there was longer stent patency in patients undergoing the SIS technique. This result suggests that SIS may be the preferred technique for bilateral palliative metal stent deployment in patients with inoperable MHBO.
Palliative biliary drainage is an increasingly performed procedure, but without consensus on the optimal technique, SIS or SBS. There is a small number of comparative studies in the literature. Future RCTs will have an important role in elucidating the most optimal drainage technique.