目的:内镜胆道支架置入术是治疗恶性胆道梗阻(MBO)的重要手段。然而,MBO管理期间放置金属支架(MS)或塑料支架(PS)的最佳位置,无论是在Oddi(SO)括约肌上方(毛细管上)还是跨(经毛细管),还没有被彻底评估。这项荟萃分析旨在比较MBO患者的经内镜逆行胰胆管造影术(ERCP)引导的胆道支架放置在SO上方和上方的临床结果。
方法:对电子数据库进行了全面搜索,以确定从开始到2022年4月发表的研究。检查的临床结果包括支架通畅,支架闭塞,和总体不良事件(AE),如胆管炎,ERCP术后胰腺炎(PEP),胆囊炎,支架迁移,和出血。随机效应模型或固定效应模型的选择是基于异质性的存在。
结果:共分析了12篇文献,涉及751例患者。结果表明,与经乳头入路相比,经乳头入路的支架通畅性更长(平均差异:38.58;95%置信区间16.02-61.14,P<0.0001)。此外,毛细血管上入路与较低的支架闭塞风险和总体不良事件相关(分别为P=0.04,P=0.002),特别是在PEP的发生率(P=0.009)。胆管炎的发病率,胆囊炎,支架迁移,乳头上和经乳头入路的出血情况相似。亚组分析表明,毛细血管上PS在支架闭塞的发生率和更长的支架通畅性方面显着降低。而与经乳头入路相比,在总体AE和PEP的发生率方面有显著下降.
结论:与经乳头法相比,毛细血管上支架在更长的支架通畅性方面具有优势,支架闭塞和总体不良事件发生率较低,尤其是,PEP发生率较低。胆管炎的发病率,胆囊炎,支架迁移,乳头上和经乳头入路的出血情况相似。需要进一步的大规模随机对照研究来证实我们的发现。
背景:CRD4202236435.
Endoscopic biliary stenting is an essential treatment for malignant biliary obstruction (MBO). However, the optimal location for the placement of metal stents (MS) or plastic stents (PS) during the management of MBO, whether above (suprapapillary) or across (transpapillary) the sphincter of Oddi (SO), has not been thoroughly evaluated. This meta-analysis aims to compare the clinical outcomes associated with endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary stents placed above and across the SO in patients with MBO.
A comprehensive search of electronic databases was carried out to identify studies published from inception to April 2022. The clinical outcomes examined including stent patency, stent occlusion, and overall adverse events (AEs) such as cholangitis, post-ERCP pancreatitis (PEP), cholecystitis, stent migration, and bleeding. The selection of a random-effects model or fixed-effects model was based on the presence of heterogeneity.
A total of 12 articles involving 751 patients were analyzed. The findings showed that the suprapapillary approach had longer stent patency compared to the transpapillary approach (mean difference: 38.58; 95% confidence interval 16.02-61.14, P < 0.0001). Additionally, the suprapapillary approach was associated with a lower risk of stent occlusion and overall AEs (P = 0.04, P = 0.002, respectively), particularly in the incidence of PEP (P = 0.009). The incidence of cholangitis, cholecystitis, stent migration, and bleeding were similar between the suprapapillary and transpapillary approaches. The subgroup analyses indicated that suprapillary PS had a significant decrease in the incidence of stent occlusion and longer stent patency, while suprapillary MS had a significant decrease in the incidence of overall AEs and PEP than the transpapillary approach.
Compared with the transpapillary approach, the suprapapillary stent had superiority in longer stent patency, lower rates of stent occlusion and overall AEs, and notably, a lower incidence of PEP. The incidence of cholangitis, cholecystitis, stent migration, and bleeding were similar between the suprapapillary and transpapillary approaches. Further large-scale randomized controlled studies are needed to confirm our findings.
CRD42022336435.