目的:在不可切除的恶性胆道梗阻(MBO)患者中,内镜胆道引流术是首选治疗方法。自膨胀金属支架(SEMS)主要用于此目的,激光切割与编织SEMS的比较结果数据有限。在这里,我们进行了首次系统评价和荟萃分析,以研究编织和激光切割SEMS在MBO中的有效性和安全性.
方法:多个数据库,包括Medline,Scopus,和Embase,(2022年5月)使用特定术语进行了搜索,以评估MBO中编织和激光切割SEMS的结果。感兴趣的结果是技术和临床成功,复发性胆道梗阻,和不良事件。使用随机效应模型采用标准荟萃分析方法。I2%异质性用于评估异质性。
结果:七项研究纳入最终分析。(激光切割:271名患者,46%的女性,平均年龄70岁;编织:282名患者,47%的女性,平均年龄72岁)。激光切割SEMS的技术成功率和临床成功率为99%(95%CI[95-99;I2=0%]),86%[60-96;I2=74%],和98%[96-99;I2=0%],89%[74-95;I2=78%]编织。激光切割SEMS的复发性胆道梗阻合并率为26%[14-43;I2=88%]和12%[5-27;I2=56%)。合并的总不良事件在激光切割中为11%[5-21;I2=77%],在编织中为12%[6-24;I2=63%]。
结论:我们的荟萃分析显示,MBO中激光切割和编织SEMS的临床结果相似。考虑到可比的性能,成本-效果分析可能有助于MBO患者选择一种类型与另一种类型.
In patients with unresectable malignant biliary obstruction (MBO), endoscopic biliary drainage is the treatment of choice. Self-expanding metallic stents (SEMS) are mainly used for this purpose, and data is limited on the comparative outcomes of laser-cut versus braided SEMS. Herein, we performed the first systematic review and meta-analysis to study the effectiveness and safety of braided and laser-cut SEMS in MBO.
Multiple databases, including Medline, Scopus, and Embase, were searched (in May 2022) using specific terms for studies evaluating the outcomes of braided and laser-cut SEMS in MBO. Outcomes of interest were technical and clinical success, recurrent biliary obstruction, and adverse events. Standard meta-analysis methods were employed using the random-effects model. I2% heterogeneity was used to assess the heterogeneity.
Seven studies were included in the final analysis. (Laser-cut: 271 patients, 46% females, mean age 70 years; and braided: 282 patients, 47% females, mean age 72 years). The pooled rate of technical success and clinical success with laser-cut SEMS was 99% (95% CI [95-99; I2 = 0%]), 86% [60-96; I2 = 74%], and 98% [96-99; I2 = 0%], 89% [74-95; I2 = 78%] with braided. The pooled rate of recurrent biliary obstruction with laser-cut SEMS was 26% [14-43; I2 = 88%] and 12% [5-27; I2 = 56%) with braided. Pooled total adverse events were 11% [5-21; I2 = 77%] in laser-cut and 12% [6-24; I2 = 63%] in braided.
Our meta-analysis demonstrates similar clinical outcomes with laser-cut and braided SEMS in MBO. Given the comparable performance, a cost-effectiveness analysis might help in choosing one type versus another in patients with MBO.