A meta-analysis and systematic review: Success of endoscopic ultrasound guided biliary stenting in patients with inoperable malignant biliary strictures and a failed ERCP.
A meta-analysis and systematic review: Success of endoscopic ultrasound guided biliary stenting in patients with inoperable malignant biliary strictures and a failed ERCP.
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荟萃分析和系统综述：内窥镜超声引导性胆道支架的成功，患有无法手术的恶性胆道狭窄和ERCP失败。
DOI：
10.1097/md.0000000000005154
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发表时间：
2017-01
期刊：
影响因子：
1.6
通讯作者：
Puli SR
中科院分区：
文献类型：
--
作者：
Moole H;Bechtold ML;Forcione D;Puli SR
在无法手术的恶性胆管狭窄患者中，内镜逆行胰胆管造影术（ERCP）引导的胆道支架植入术在5%至10%的患者中失败，原因是解剖结构困难/无法插入乳头。最近，内镜超声引导胆道引流（EUS-BD）已被描述。主要结局是评价EUS的胆道引流成功率，并将其与经皮经鞘胆道引流（PTBD）进行比较。次要结局是评价总体手术相关并发症。本分析纳入了评价EUS-BD有效性的研究，并比较了EUS-BD与PTBD在ERCP失败的无法手术的恶性胆管狭窄患者中的疗效。在Medline、PubMed和奥维德期刊中检索文章。两位作者独立检索和提取数据。根据PRISMA（系统性综述和荟萃分析的首选报告项目）声明编写研究设计。对前瞻性研究和EUS-BD与PTBD进行了亚组分析。使用固定和随机效应模型计算合并比例。I2统计量用于评估研究间的异质性。初步检索识别出846篇参考文献，选择并审查了其中124篇。本分析纳入了16项符合纳入标准的研究（N=528）。 在汇总患者人群中，使用EUS成功进行胆道引流的患者百分比为90.91%（95% CI = 88.10-93.38）。 发生EUS-PD总体手术相关并发症的患者比例为16.46%（95% CI = 13.20-20.01）。 EUS-PD组与PTBD组成功胆道引流的合并比值比为3.06（95%CI = 1.11-8.43）。 EUS-PD组与PTBD组的总体手术相关并发症风险差异为-0.21（95%CI =-0.35至-0.06）。 EUS-BD与PTBD相比，感染并发症和胆漏的相对风险分别为0.25（95%CI = 0.07-0.94）和0.33（95%CI = 0.12-0.87）。 在ERCP引导下胆道支架植入术失败的恶性胆道狭窄患者中，EUS-BD似乎是一种极好的治疗选择，其胆道引流成功率较高，并发症相对较少，优于PTBD，上级。
In patients with inoperable malignant biliary strictures, endoscopic retrograde cholangiopancreatography (ERCP) guided biliary stenting fails in 5% to 10% patients due to difficult anatomy/inability to cannulate the papilla. Recently, endoscopic ultrasound guided biliary drainage (EUS-BD) has been described. Primary outcomes were to evaluate the biliary drainage success rates with EUS and compare it to percutaneous transhepatic biliary drainage (PTBD). Secondary outcomes were to evaluate overall procedure related complications. Studies evaluating the efficacy of EUS-BD and comparing EUS-BD versus PTBD in inoperable malignant biliary stricture patients with a failed ERCP were included in this analysis. Articles were searched in Medline, PubMed, and Ovid journals. Two authors independently searched and extracted data. The study design was written in accordance to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Subgroup analyses of prospective studies and EUS-BD versus PTBD were performed. Pooled proportions were calculated using fixed and random effects model. I2 statistic was used to assess heterogeneity among studies. Initial search identified 846 reference articles, of which 124 were selected and reviewed. Sixteen studies (N = 528) that met the inclusion criteria were included in this analysis. In the pooled patient population, the percentage of patients that had a successful biliary drainage with EUS was 90.91% (95% CI = 88.10–93.38). The proportion of patients that had overall procedure related complications with EUS-PD was 16.46% (95% CI = 13.20–20.01). The pooled odds ratio for successful biliary drainage in EUS-PD versus PTBD group was 3.06 (95% CI = 1.11–8.43). The risk difference for overall procedure related complications in EUS-PD versus PTBD group was −0.21 (95% CI = −0.35 to −0.06). Relative risk for infectious complications and bile leak in EUS-BD versus PTBD was 0.25 (95% CI = 0.07–0.94) and 0.33 (95% CI = 0.12–0.87), respectively. In patients with inoperable malignant biliary strictures who failed an ERCP guided biliary stenting, EUS-BD seems to be an excellent management option and superior to PTBD with higher successful biliary drainage rates and relatively fewer complications.