Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5210
Peer-review started: March 25, 2019
First decision: April 11, 2019
Revised: July 14, 2019
Accepted: August 7, 2019
Article in press: August 7, 2019
Published online: September 14, 2019
Bilateral vs unilateral biliary stenting is used for palliation in malignant biliary obstruction. No clear data is available to compare the efficacy and safety of bilateral biliary stenting over unilateral stenting.
To assess the efficacy and safety of bilateral vs unilateral biliary drainage in inoperable malignant hilar obstruction.
PubMed, Embase, Scopus, and Cochrane databases, as well as secondary sources (bibliographic review of selected articles and major GI proceedings), were searched through January 2019. The primary outcome was the re-intervention rate. Secondary outcomes were a technical success, early and late complications, and stent malfunction rate. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated for each outcome.
A total of 9 studies were included (2 prospective Randomized Controlled Study, 5 retrospective studies, and 2 abstracts), involving 782 patients with malignant hilar obstruction. Bilateral stenting had significantly lower re-intervention rate compared with unilateral drainage (OR = 0.59, 95%CI: 0.40-0.87, P = 0.009). There was no difference in the technical success rate (OR = 0.7, CI: 0.42-1.17, P = 0.17), early complication rate (OR = 1.56, CI: 0.31-7.75, P = 0.59), late complication rate (OR = 0.91, CI: 0.58-1.41, P = 0.56) and stent malfunction (OR = 0.69, CI: 0.42-1.12, P = 0.14) between bilateral and unilateral stenting for malignant hilar biliary strictures.
Bilateral biliary drainage had a lower re-intervention rate as compared to unilateral drainage for high grade inoperable malignant biliary strictures, with no significant difference in technical success, and early or late complication rates.
Core tip: Biliary drainage is useful to control jaundice and cholangitis in patients with inoperable malignant hilar strictures. No consensus guidelines are available to decide if bilateral stenting has any advantage over unilateral stenting. This meta-analysis adds to the growing body of evidence that bilateral stenting is technically feasible with similar early and late complications and leads to lower re-intervention rates.