Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2021; 13(5): 493-506
Published online May 27, 2021. doi: 10.4240/wjgs.v13.i5.493
Biliary drainage in inoperable malignant biliary distal obstruction: A systematic review and meta-analysis
Maria Vitória Cury Vieira Scatimburgo, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Vitor Massaro Takamatsu Sagae, Bruno Salomão Hirsch, Mateus Bond Boghossian, Thomas R McCarty, Marcos Eduardo Lera dos Santos, Tomazo Antonio Prince Franzini, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
Maria Vitória Cury Vieira Scatimburgo, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Vitor Massaro Takamatsu Sagae, Bruno Salomão Hirsch, Mateus Bond Boghossian, Marcos Eduardo Lera dos Santos, Tomazo Antonio Prince Franzini, 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
Thomas R McCarty, Division of Gasteoenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA 02115, United States
Author contributions: Scatimburgo MVCV, de Moura DTH, Sagae VMT, dos Santos MEL, and Franzini TAP contributed to the data acquisition; Scatimburgo MVCV, de Moura DTH, Sagae VMT, Boghossian MB, Bernardo WM, de Moura EGH, Ribeiro IB, and Hirsch BS analyzed and interpretated data; Scatimburgo MVCV, de Moura DTH, Sagae VMT, Boghossian MB, de Moura EGH, Ribeiro IB, and Hirsch BS revised the article; Scatimburgo MVCV, de Moura DTH, Sagae VMT, dos Santos MEL, Franzini TAP, Bernardo WM, and de Moura EGH drafted the article; Scatimburgo MVCV, de Moura DTH, Franzini TAP, Bernardo WM, and de Moura EGH contributed to final approval; McCarty TR reviewed the English.
Conflict-of-interest statement: The authors do not have any conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist statement, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist statement.
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 24, 2021
Peer-review started: January 24, 2021
First decision: March 29, 2021
Revised: March 30, 2021
Accepted: April 23, 2021
Article in press: April 23, 2021
Published online: May 27, 2021
ARTICLE HIGHLIGHTS
Research background

The drainage endoscopic in patients with inoperable and/or irresectable malignant distal biliary obstruction (MDBO) has several advantages such as patient comfort, increased survival and fewer complications due to biliary obstruction. However, there are two types of stents, self-expanding metal stent (SEMS) and plastic stent (PS), leading to much discussion about which one to use, due to their different characteristics.

Research motivation

In many cases, MDBO have no curative perspective by the time of diagnosis. Therefore, palliative treatment for bile duct clearance plays a major role, since they provide longer life expectancy and better quality of life. Therefore, we wanted to compare the two types of stents commonly used in an attempt to understand which approach is best.

Research objectives

To perform a systematic review and meta-analysis of Randomized Controlled Trials comparing plastic vs metal stents in palliative treatment of MDBO.

Research methods

We performed a systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Electronic searches were performer using MEDLINE, EMBASE, Central Cochrane, Latin American and Caribbean Health Sciences Literature databases. Only randomized control trials were included. The outcomes studied were stent dysfunction rate, reintervention rate, duration of patency, mean survival, complications, and clinical success.

Research results

Twelve randomized clinical trials were included in the final analysis with a total of 1005 patients, of whom 681 belonged to the SEMS group and 542 to the PS group. The SEMS group was divided into three subgroups, uncovered metal stent (uSEMS), partially/fully covered (pcSEMS/cSEMS) and the group in which the SEMS was not specified (SEMS not specified). SEMS had a lower dysfunction rate than the PS and in the analysis of the subgroups, uSEMS had no difference comparing to PS and pcSEMS/cSEMS was higher. Regarding reintervention, SEMS had a lower reintervention rate compared to PS. Concerning duration of patency, SEMS also showed advantage than PS. In the three subgroups of the SEMS, there was longer duration of patency. In the mean survival analysis, there was no difference between SEMS and PS, however, in the analysis of the subgroups, pcSEMS/cSEMS favored over the PS. Regarding complications rate and clinical success were similar in both groups, and have no significant difference.

Research conclusions

Our study showed that SEMS presents a higher duration of patency, lower reintervention rate, and lower dysfunction rate when compared to the use of PS. There was no difference between the methods in concern of survival analysis, clinical success and rate of complications.

Research perspectives

The use of SEMS was a great advent in palliative therapy for MDBO. In our study, the use of SEMS revealed even more benefits in most cases. We hope that this study can clarify its benefit and that more patients can be benefited in deciding the type of stent used from here.