Abstract：
OBJECTIVE: Biliary drainage is vital in managing malignant biliary obstruction (MBO). Suprapapillary stenting has emerged as a viable alternative to transpapillary stenting and is performed using inside plastic (iPS) or metal stents (iMS). This meta-analysis aims to evaluate the outcomes of suprapapillary stent placement for MBO.
METHODS: The Embase, PubMed, and Web of Science databases were systematically searched to include all studies published before September 31, 2023, that reported on the outcomes of suprapapillary stents placed for MBO. Using the random-effect model, the pooled, weight-adjusted event rate estimate for the clinical outcomes was calculated with 95% confidence intervals (CIs).
RESULTS: Twenty-eight studies were included, with a total of 1401 patients. The pooled clinical success rate was 98.9%. A subgroup analysis yielded non-significant differences between the iPS and iMS groups (99.3% vs. 98.6%, respectively; P = 0.44). The pooled incidence rate of adverse events (AE) with suprapapillary stents was 9.5%. In a subgroup analysis, the incidence of AEs with iPS was 10.7% compared to 9% in the iMS group without a statistical difference (P = 0.32). The most common adverse event was cholangitis (2.2%), followed by pancreatitis (1.1%), cholecystitis (0.5%), and bleeding (0.12%).
CONCLUSIONS: When technically feasible, suprapapillary stenting for MBO is a viable endoscopic option with a high clinical success rate and acceptable adverse event rates. Both iPS and iMS exhibit similar efficacy.
METHODS: The Embase, PubMed, and Web of Science databases were systematically searched to include all studies published before September 31, 2023, that reported on the outcomes of suprapapillary stents placed for MBO. Using the random-effect model, the pooled, weight-adjusted event rate estimate for the clinical outcomes was calculated with 95% confidence intervals (CIs).
RESULTS: Twenty-eight studies were included, with a total of 1401 patients. The pooled clinical success rate was 98.9%. A subgroup analysis yielded non-significant differences between the iPS and iMS groups (99.3% vs. 98.6%, respectively; P = 0.44). The pooled incidence rate of adverse events (AE) with suprapapillary stents was 9.5%. In a subgroup analysis, the incidence of AEs with iPS was 10.7% compared to 9% in the iMS group without a statistical difference (P = 0.32). The most common adverse event was cholangitis (2.2%), followed by pancreatitis (1.1%), cholecystitis (0.5%), and bleeding (0.12%).
CONCLUSIONS: When technically feasible, suprapapillary stenting for MBO is a viable endoscopic option with a high clinical success rate and acceptable adverse event rates. Both iPS and iMS exhibit similar efficacy.
摘要：
目的：胆道引流对治疗恶性胆道梗阻（MBO）至关重要。乳头状支架置入术已成为跨乳头状支架置入术的可行替代方案，并使用内部塑料（iPS）或金属支架（iMS）进行。这项荟萃分析旨在评估MBO的毛细血管上支架置入的结果。
方法：Embase，PubMed,系统检索了WebofScience数据库,包括2023年9月31日之前发表的所有研究,这些研究报告了用于MBO的乳头上支架的结局.使用随机效应模型，集合，以95%置信区间(CIs)计算临床结局的重量校正事件发生率估计值.
结果：纳入了28项研究，共有1401名患者。合并临床成功率为98.9%。亚组分析得出iPS和iMS组之间的差异无统计学意义（99.3％vs.98.6%,分别为；P=0.44)。使用乳头上支架的不良事件（AE）的合并发生率为9.5％。在亚组分析中，iPS不良事件发生率为10.7%,iMS组为9%,无统计学差异(P=0.32).最常见的不良事件是胆管炎（2.2%），其次是胰腺炎(1.1%)，胆囊炎（0.5%），出血（0.12%）。
结论：在技术上可行时，用于MBO的乳头上支架置入术是一种可行的内镜选择,具有较高的临床成功率和可接受的不良事件发生率.iPS和iMS都表现出相似的功效。
方法：Embase，PubMed,系统检索了WebofScience数据库,包括2023年9月31日之前发表的所有研究,这些研究报告了用于MBO的乳头上支架的结局.使用随机效应模型，集合，以95%置信区间(CIs)计算临床结局的重量校正事件发生率估计值.
结果：纳入了28项研究，共有1401名患者。合并临床成功率为98.9%。亚组分析得出iPS和iMS组之间的差异无统计学意义（99.3％vs.98.6%,分别为；P=0.44)。使用乳头上支架的不良事件（AE）的合并发生率为9.5％。在亚组分析中，iPS不良事件发生率为10.7%,iMS组为9%,无统计学差异(P=0.32).最常见的不良事件是胆管炎（2.2%），其次是胰腺炎(1.1%)，胆囊炎（0.5%），出血（0.12%）。
结论：在技术上可行时，用于MBO的乳头上支架置入术是一种可行的内镜选择,具有较高的临床成功率和可接受的不良事件发生率.iPS和iMS都表现出相似的功效。
