Percutaneous biliary stent combined with brachytherapy using 125I seeds for treatment of unresectable malignant obstructive jaundice: A meta-analysis

Table 1 Study information and patient characteristics of this Meta-analysis

Ref.	Design	Country	Period of enrolment	Groups	Number of patients	Age (yr)	Sex (male/female)	Obstruction levels	Causes of MOJ
Chen et al[25], 2012	Single-centre, RCT	China	Mar. 2009-Jan. 2010	125I + stent	17	61.2 ± 14.5	12/5	Hilar and distal	Cholangiocarcinoma (n = 7), hepatocellular carcinoma (n = 2), pancreatic cancer (n = 3), hepatic metastases from the stomach or colorectum (n = 5)
				Stent	17	63.9 ± 9.3	10/7		Cholangiocarcinoma (n = 6), hepatocellular carcinoma (n = 4), pancreatic cancer (n = 3), hepatic metastases from the stomach or colorectum (n = 4)
Hasimu et al[13], 2017	Single-centre, RCT	China	July 2011-June 2014	125I + stent	28	70.93 ± 8.58	11/17	Hilar and distal	Cholangiocarcinoma (n = 48), gallbladder cancer (n = 7)
				Stent	27	70.26 ± 9.71	14/13
Chen et al[26], 2018	Single-centre, RCT	China	Sep. 2014-Nov. 2016	125I + stent	13	66 (49, 88)	8/5	Lower	Pancreatic head carcinoma (n = 7), gallbladder carcinoma (n = 4), bile duct carcinoma (n = 2)
				Stent	19	68 (48, 86)	12/7		Pancreatic head carcinoma (n = 11), bile duct carcinoma (n = 5), gallbladder carcinoma (n = 2), ampullary carcinoma (n = 1)
Jiao et al[14], 2017	Single-centre, RCT	China	Jan. 2013- Jan. 2015	125I + stent	31	60.4 ± 8.8	12/17	Hilar and distal	Primary adenocarcinoma (n = 19), metastatic adenocarcinoma (n = 12)
				Stent	30	60.2 ± 8.1	16/14		Primary adenocarcinoma (n = 21), metastatic adenocarcinoma (n = 9)
Zhu et al[20], 2012	Single-centre, RCT	China	Nov. 2008-Oct. 2010	125I + stent	12	62.5 ± 21.0	7/5	Hilar and distal	Primary adenocarcinoma (n = 8), metastatic adenocarcinoma (n = 4)
				Stent	11	71.0 ± 22.0	9/2		Primary adenocarcinoma (n = 5), metastatic adenocarcinoma (n = 6)
Zhu et al[21], 2018	Multicentre, RCT	China	Oct. 2013-Mar. 2016	125I + stent	164	65.0 (56.0, 75.0)	103/61	Hilar and distal	Biliary tract cancer (n = 80), pancreatic carcinoma (n = 46), lymph node metastases (n = 38)
				Stent	164	64.0 (57.0, 75.0)	109/55		Biliary tract cancer (n = 74), pancreatic carcinoma (n = 53), lymph node metastases (n = 37)
Pan et al[15], 2020	Retrospective cohort study	China	Mar. 2014-Dec. 2017	125I + stent	30	56.53 ± 12.24	23/7	Hilar and distal	NR
				Stent	54	60.44 ± 11.83	35/19
Wang et al[24], 2017	Retrospective cohort study	China	Sep. 2010-Feb. 2013	125I + stent	24	57.3 (41, 80)	29/21	Hilar and distal	Holangiocarcinoma (n = 18), pancreatic head carcinoma (n = 14), hilar lymph node metastasis (n = 12), ampullary carcinoma (n = 6)
				Stent	26
Zhou et al[22], 2019	Retrospective cohort study	China	Nov. 2015-Oct. 2017	125I + stent	45	61.7 (32, 87)	31/14	Hilar, middle and distal	Cholangiocarcinoma (n = 18), gallbladder carcinoma (n = 6), pancreatic carcinoma (n = 4), hepatocellular carcinoma (n = 7), gastric cancer (n = 7), ampullary cancer (n = 0), hilar node metastases from other solid malignancies (n = 3)
				Stent	87	64.4 (35, 92)	59/28		Cholangiocarcinoma (n = 32), gallbladder carcinoma (n = 9), pancreatic carcinoma (n = 17), hepatocellular carcinoma (n = 9), gastric cancer (n = 11), ampullary cancer (n = 1), hilar node metastases from other solid malignancies (n = 8)
Zhou et al[23], 2020	Retrospectively cohort study	China	Jan. 2017-June 2018	125I + stent	40	70.2 ± 13.8	21/19	Hilar	Cholangiocarcinoma (n = 22), pancreatic cancer (n = 10), gallbladder cancer (n = 2), duodenal cancer (n = 2), metastatic cancer (n = 4)
				stent	36	68.1 ± 12.2	21/15		Cholangiocarcinoma (n = 19), pancreatic cancer (n = 8), gallbladder cancer (n = 3), duodenal cancer (n = 1), metastatic cancer (n = 5)

MOJ: Malignant obstructive jaundice; RCT: randomized controlled trial.

Table 2 Procedure details and outcomes of studies included in the meta-analysis

Ref.	Intervention	Stent manufacturer and typea	Outcomes
Chen et al[25], 2012	125I seed strands performed after stent insertion	Nitinol self-expendable stent (Luminexx III; BARD); Type I	Laboratory values before and after stent placement, complications, stent patency
	Conventional stent
Hasimu et al[13], 2017	Biliary stent with 125I seed strands	Nitinol self-expandable stent (S.M.A.R.T.; Cordis Corporation, Miami Lakes, FL, United States); Type III	Stent patency, survival, relief of symptoms, technical and clinical success, complications, laboratory values before and after stent placement, radiation safety
	Conventional stent
Chen et al[26], 2018	125I seeds-loaded-biliary stent	Self-expendable stent (produced by Mirco-tech, Nanjing, China); Type II	Laboratory values before and after stent placement, complications, stent patency, survival, CR, PR, SD, PD
	Conventional stent
Jiao et al[14], 2017	SEMS with 125I seed strands	A Nitinol self-expendable stent (Niti-S Biliary stent, Taewoong, Seoul, Korea); Type I	Technical success, laboratory values before and after stent placement, stent patency, overall survival, early or late complications
	Conventional stent
Zhu et al[20], 2012	125I seeds-loaded-biliary stent	Outer self-expandable 125I radioactive seeds-loaded stent and inner conventional self-expanding biliary nitinol alloy stent (Nanjing MicroInvasive Medical Inc., Nanjing, China); Type II	Technical success, jaundice relief, radiation safety, complications (subjective and objective), survival, stent patency, laboratory values before and after stent placement
	Conventional stent
Zhu et al[21], 2018	125I seeds-loaded-biliary stent	Inner conventional uncovered SEMS (Nanjing Micro-Tech Co. Ltd., Nanjing, China) and outer 125I seed-Xloaded stent; Type II	Stent restenosis, patency time, technical success, relief of jaundice, survival, complications
	Conventional stent
Pan et al[15], 2020	Biliary stent with 125I seed strands	Biliary stent (E-Luminexx Biliary Stent; Wachhausstrasse 6D76227, BARD Corporation, Karlsruhe, Germany); Type III	Stent patency, overall survival, complications, laboratory values before and after stent placement, independent factors associated with survival
	Conventional stent
Wang et al[24], 2017	Biliary stent with 125I seed strands	Biliary internal stent (Micro-Tech Co., Ltd. Nanjing, China); Type I	Success rate, laboratory values before and after stent placement, stent patency, survival
	Conventional stent
Zhou et al[22], 2019	UCSEMS with 125I seed strands	Three types of SEMS [E-Luminexx (Bard Peripheral Vascular, Tempe, AZ, United States), S.M.A.R.T (Cordis, Milpitas, CA, United States), and Zilver (Cook Medical, Bloomington, IN, United States)];Type III	Technical success, clinical success, complications, follow-up time, stent patency, survival, laboratory values before and after stent placement
	UCSEMS
Zhou et al[23], 2020	SEMS with 125I seed strands	Self-expandable metallic stent (Cook Medical, Bloomington, IN, United States); Type III	Technical success, clinical success, laboratory values before and after stent placement, complications, overall survival, and stent patency
	Conventional stent

^aThe ¹²⁵I seed stents include three types. Type I: Self-expanded stent with ¹²⁵I seed strand fixation in a drainage catheter; Type II: ¹²⁵I seed-loaded stent; Type III: Self-expanded stent with ¹²⁵I seed strand fixation between stent and the bile duct wall.