Published online Dec 16, 2021. doi: 10.12998/wjcc.v9.i35.10979
Peer-review started: June 24, 2021
First decision: July 27, 2021
Revised: August 3, 2021
Accepted: November 2, 2021
Article in press: November 2, 2021
Published online: December 16, 2021
Processing time: 168 Days and 15.4 Hours
Malignant obstructive jaundice (MOJ) is a common pathologic manifestation of malignant biliary obstruction. Recently, several clinical trials have explored the clinical effectiveness of intraluminal 125I seed-based brachytherapy for MOJ patients, and various outcomes have been reported.
To assess the efficacy and safety of percutaneous biliary stents with 125I seeds compared to conventional metal stents in patients with unresectable MOJ.
A systematic search of English-language databases (PubMed, Embase, Cochrane Library, and Web of Science) was performed to identify studies published prior to June 2020 that compared stents with or without 125I seeds in the treatment of unresectable MOJ. The outcomes analyzed included primary outcomes (stent patency and overall survival) and secondary outcomes (complications and liver function parameters).
Six randomized controlled trials and four retrospective studies involving 875 patients were eligible for the analysis. Of the 875 included patients, 404 were treated with 125I seed stents, while 471 were treated with conventional stents. Unadjusted pooled analysis demonstrated that compared to conventional stents,
Placement of stents combined with brachytherapy using 125I seeds contributes to a longer stent patency and higher overall survival than placement of conventional stents without extra complications or severe liver damage. Thus, it can be considered an effective and safe treatment for unresectable MOJ.
Core Tip: In recent years, the incidence of malignant obstructive jaundice (MOJ) in Asia has been 40 times higher than that in the Western world, which is a vital issue that requires significant attention. Irradiation stents using 125I seeds have been widely applied in the treatment of unresectable MOJ. However, more convincing evidence-based reviews of the efficacy and safety of 125I seed stents are needed. We used the latest data to further validate the superiority of 125I seed stents, providing strong evidence for clinicians to make correct decisions in clinical practice. Furthermore, we found that 125I seed stents resulted in equivalent complication and serum index outcomes as conventional stents, indicating that 125I seed stents are safe and well tolerated.