Unilateral versus bilateral endoscopic stenting in patients with unresectable malignant hilar obstruction: a systematic review and meta-analysis

Abstract

Background and study aims Endoscopic stent placement is used for palliative management of unresectable malignant hilar obstruction, which could be achieved by either unilateral or bilateral stent insertion. Materials and methods A literature search was performed to identify studies that reported outcomes of metallic biliary stent placement in patients with malignant hilar obstruction. Weighted pooled rates (WPR) along with 95 % confidence intervals (95 %CI) were calculated to determine and compare outcomes including technical and functional success, early and late adverse events, post procedure cholangitis, and stent occlusion between two groups. Results A total of 21 studies with 1292 patients were included. WPR of technical success was significantly higher in the unilateral group (97 %, 95 %CI: 93 –98 %) vs. bilateral group (89 %, 95 %CI: 84 –92 %) (P = 0.0.003). WPR for functional success in the unilateral and bilateral groups were 96 % (95 %CI: 91 –98 %) and 94 % (95 %CI: 91 –97 %), respectively (P = 0.48). The rate of early and late complications was comparable between the two groups. Conclusion In patients with unresectable malignant hilar obstruction, unilateral and bilateral metallic stenting techniques are comparable in terms of efficacy and safety.

Diagnosis and treatment of biliary malignancies: biopsy, cytology, cholangioscopy and stenting

“…Several studies have investigated unilateral (left or the right duct system) or bilateral stenting. De Palma et al [78] in their RCT of 157 patients with hilar obstruction, comparing unilateral and bilateral stenting, demonstrated superior stent insertion rates with unilateral stenting (88.6% vs. 76.9%, P = 0.04) and higher complication rates with bilateral stenting (26.9% vs. 18.9%, P = 0.03) on intention-to-treat analysis. A meta-analysis by Aghaie Meybodi et al [79] of 1300 patients with hilar strictures demonstrated comparable efficacy and safety for unilateral and bilateral stenting.…”

Personalized Endoscopy in Complex Malignant Hilar Biliary Strictures

“…Several studies investigated whether the biliary drainage should be unilateral or bilateral [ 68 , 69 , 70 ]. On one hand, the unilateral drainage raises the issue of insufficient jaundice relief and risk of infective complications occurrence, on the other hand, bilateral stenting is burden by a higher technical complexity.…”

“…In a multicenter, prospective, randomized study unilateral and bilateral endoscopic drainage showed similar results in terms of success rate, but unilateral stenting was associated with a higher risk for reintervention and shorter patency time [ 71 ]. In a recent meta-analysis of 21 studies involving 1292 patients with malignant HBO, Meybodi M. et al reported that the technical success and the functional success rate were higher in unilateral drainage when compared with the bilateral [ 70 ]. Short-term and long-term complication rates were comparable in the two groups [ 70 ].…”

“…In a recent meta-analysis of 21 studies involving 1292 patients with malignant HBO, Meybodi M. et al reported that the technical success and the functional success rate were higher in unilateral drainage when compared with the bilateral [ 70 ]. Short-term and long-term complication rates were comparable in the two groups [ 70 ]. In another meta-analysis, bilateral stenting, considering both SEMS and PS, has been shown to be more effective in lowering hyperbilirubinemia [ 69 ].…”

Plastic versus metal stents for inoperable gallbladder cancer with hilar biliary obstruction: the jury is still out

“…Technical success was significantly higher in the unilateral group compared to the bilateral group (97% vs. 89%; P=0.003). Clinical success rate (98% vs. 94%; P=0.48) and complications were comparable between the 2 groups [ 47 ]. In a retrospective study by Naitoh et al , comparison of endoscopic unilateral and bilateral biliary metal stenting was performed in patients with MHS [ 42 ].…”