Meta-Analysis of the Long Term Success Rate of Different Interventions in Benign Biliary Strictures

Abstract

BackgroundBenign biliary stricture is a rare condition and the majority of the cases are caused by operative trauma or chronic inflammation based on various etiology. Although the initial results of endoscopic, percutaneous and surgical treatment are impressive, no comparison about long term stricture resolution is available.AimsThe goal of this study was to compare the long term disease free survival in benign biliary strictures with various etiology after surgery, percutaneous transhepatic—and endoscopic treatment.MethodsPubMed, Embase, and Cochrane Library were searched by computer and manually for published studies. The investigators selected the publications according to the inclusion and exclusion criteria, processed the data and assessed the quality of the selected studies. Meta-analysis of data of 24 publications was performed to compare long term disease free survival of different treatment groups.ResultsCompared the subgroups surgery resulted in the highest long term stricture resolution rate, followed by the percutaneous transhepatic treatment, the multiple plastic stent insertion and covered self-expanding metal stents (SEMS), however the difference was not significant. All compared methods are significantly superior to the single plastic stent placement. Long term stricture resolution rate irrespectively of any therapy is still not more than 84%.ConclusionsIn summary, the use of single plastic stent is not recommended. Further randomized studies and innovative technical development are required for improving the treatment of benign biliary strictures.

Benign Biliary Strictures: A Systematic Review on Endoscopic Treatment Options

“…Several meta-analyses have demonstrated that SEMSs were similar to MPS for BBS resolution whilst requiring fewer ERCP procedures [15,16]. In one meta-analysis, surgery yielded the highest long-term stricture resolution rate (84%), but the difference with other treatment modalities was not significant [17]. However, all meta-analyses used studies with small numbers.…”

“…In addition, there was great heterogeneity within the studies themselves, with many not detailing the types of prosthesis or design for the stents [13] used nor the exchange frequency. The protocols varied greatly within studies, with I 2 being quoted from 57% [18] to 96% [17] without elaboration in the discussion. Meta-analyses may not be the best modality to answer the debate between metal vs. plastic stents.…”

Complex percutaneous biliary procedures: Review and contributions of a high volume team

“…66 Additionally, a recent meta-analysis concluded that the endoscopic treatment had the same long-term patency as surgical treatments and would be the first line treatment due to the lower risk of complications, easy implementation, and cost-effectiveness. 71 There is still controversy between the use of a fully covered metallic stent and this endoscopic technique of multiples plastic stents. A recent metanalysis concluded that both have the same efficacy but with a slight advantage in favour of the former due to the fewer procedures needed to achieve the dilation.…”

Digital Single-Operator Cholangioscopy in the Management of Biliary Strictures - Our Initial Institutional Experience

“…The vast majority of biliary strictures (BSs) are malignant but data from surgical literature suggest that 15-24 % of patients undergoing surgical resection of a suspected bile duct carcinoma have benign etiology (1,2). BSs are considered to be indeterminate when a diagnosis can't be established upon basic laboratory work-up, abdominal imaging and ERCP with standard biliary sampling with brush cytology (2,3).…”