Double Stenting for Malignant Biliary and Duodenal Obstruction: A Systematic Review and Meta-Analysis

Anna Fábián, Renáta Bor, Noémi Gede, Péter Bacsur, Dániel Pécsi, Péter Hegyi, Barbara Tóth, Zsolt Szakács, Áron Vincze, István Ruzsics, Zoltán Rakonczay, Bálint Erőss, Róbert Sepp, Zoltán Szepes

Research output: Article

Abstract

INTRODUCTION: Data about the efficacy of palliative double stenting for malignant duodenal and biliary obstruction are limited. METHODS: A systematic literature search was performed to assess the feasibility and optimal method of double stenting for malignant duodenobiliary obstruction compared with surgical double bypass in terms of technical and clinical success, adverse events, reinterventions, and survival. Event rates with 95% confidence intervals were calculated. RESULTS: Seventy-two retrospective and 8 prospective studies published until July 2018 were included. Technical and clinical success rates of double stenting were 97% (95%-99%) and 92% (89%-95%), respectively. Clinical success of endoscopic biliary stenting was higher than that of surgery (97% [94%-99%] vs 86% [78%-92%]). Double stenting was associated with less adverse events (13% [8%-19%] vs 28% [19%-38%]) but more frequent need for reintervention (21% [16%-27%] vs 10% [4%-19%]) than double bypass. No significant difference was found between technical and clinical success and reintervention rate of endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic drainage, and endoscopic ultrasound-guided biliary drainage. ERCP was associated with the least adverse events (3% [1%-6%]), followed by percutaneous transhepatic drainage (10% [0%-37%]) and endoscopic ultrasound-guided biliary drainage (23% [15%-33%]). DISCUSSION: Substantially high technical and clinical success can be achieved with double stenting. Based on the adverse event profile, ERCP can be recommended as the first choice for biliary stenting as part of double stenting, if feasible. Prospective comparative studies with well-defined outcomes and cohorts are needed.

Original languageEnglish
Pages (from-to)e00161
JournalClinical and translational gastroenterology
Volume11
Issue number4
DOIs
Publication statusPublished - ápr. 1 2020

ASJC Scopus subject areas

  • Gastroenterology

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    Fábián, A., Bor, R., Gede, N., Bacsur, P., Pécsi, D., Hegyi, P., Tóth, B., Szakács, Z., Vincze, Á., Ruzsics, I., Rakonczay, Z., Erőss, B., Sepp, R., & Szepes, Z. (2020). Double Stenting for Malignant Biliary and Duodenal Obstruction: A Systematic Review and Meta-Analysis. Clinical and translational gastroenterology, 11(4), e00161. https://doi.org/10.14309/ctg.0000000000000161