Stent insertion for malignant hilar obstruction: a meta-analysis of percutaneous versus endoscopic approaches

Abstract

Introduction:In an effort to treat patients with malignant hilar obstruction (MHO), both percutaneous trans-hepatic biliary stenting (PTBS) and endoscopic biliary stenting (EBS) strategies have been implemented in the clinic, but the relative advantages of these techniques remain to be clarified.Aim: This meta-analysis was designed to compare the relative clinical efficacy of PTBS and EBS in MHO patients. Material and methods: Relevant studies were identified through searches of the PubMed, Web of science, and Wanfang databases, and pooled analyses of these studies were then performed.Results: In total, this meta-analysis included 11 studies enrolling 530 and 645 patients who underwent PTBS and EBS, respectively. Pooled rates of technical success in the PTBS patients were significantly higher than those for EBS patients (p < 0.0001). PTBS patients also exhibited significantly lower pooled cholangitis (p = 0.03) and pancreatitis (p < 0.0001) rates as compared to individuals in the EBS group. However, there were no significant differences in pooled clinical success rates (p = 0.45), haemorrhage rates (p = 0.57), stent patency (p = 0.96), or overall survival (p = 0.73) when comparing these groups. In a subgroup analysis, PTBS was not found to be superior to EBS as a treatment for Bismuth type III/IV MHO patients. However, PTBS did exhibit superior technical success and complication rates relative to EBS when treating hilar cholangiocarcinoma patients.Conclusions: PTBS is superior to EBS with respect to many technical success and safety criteria when employed for the management of MHO patients.

Placing Plastic Stent via Percutaneous Transhepatic Biliary Drainage following Failure of Endoscopic Retrograde Cholangiopancreatography: Review of Case Series

“…1 Most malignant biliary tract obstructions are relieved either by bilioenteric bypass surgery or minimally invasive methods such as endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD) with biliary stent insertion. [2][3][4] Plastic biliary stent placement via endoscopic route is a well-established technique to treat biliary obstruction in cases with both non-malignant and malignant causes. On the other hand, percutaneous insertion of a biliary plastic stent is less commonly done.…”

“…Most patients for percutaneous approach are referred to IR after failure of endoscopic intervention or if there is anatomical change after a procedure. 4 The aim of this study is to describe our experience with the technical procedure, patency, and complications of percutaneous biliary plastic stent insertion following failure of the endoscopic approach (►Figs. [1][2][3].…”