Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction
Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction
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DOI：
10.1016/j.gie.2011.03.1249
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发表时间：
2011-08-01
影响因子：
7.7
通讯作者：
Baron, Todd H.
中科院分区：
文献类型：
--
作者：
Saleem, Atif;Leggett, Cadman L.;Baron, Todd H.
背景资料：自膨式金属支架（SEMSs）用于缓解恶性胆道梗阻。目的：我们进行了一项荟萃分析，以比较覆膜SEMSs（CSEMSs）和未覆膜SEMSs（USEMSs）在不可切除的远端恶性胆道梗阻患者中的支架通畅性和支架存活率。设计：荟萃分析。设置：三级护理机构。患者：对多个数据库进行了全面检索（从每个数据库的最早包含日期到2010年11月，任何语言和任何人群）。检索识别出337篇潜在摘要和标题，其中16篇为全文检索。参考文献审查确定了17项其他研究。我们发现了5个多中心随机试验，涉及781名患者。干预：放置覆盖和未覆盖的SEMSs治疗远端恶性胆道梗阻。主要结果测量：支架通畅率，支架生存率，患者生存率和支架功能障碍的原因（向内生长，过度生长，迁移和污泥形成）。结果：随访时间的中位数为212天。与USEMS相比，CSEMS与显著延长的支架通畅率（加权平均差[WMD] 60. 56天; 95%置信区间[CI]，25. 96，95. 17; I-2 = 0%）和更长的支架存活率（WMD 68. 87天; 95% CI，25. 64，112. 11; I-2 = 79%）相关。CSEMSs的支架移位、肿瘤过度生长和污泥形成显著更高（相对风险[RR] 8.11; 95% CI，1.47，44.76; I-2 = 0%），（RR 2.02; 95% CI，1.08，3.78; I-2 = 0%），（RR 2.89; 95% CI，1.27，6.55; I-2 = 0%）。局限性：可用的研究数量相对较少，5项研究中有2项来自一个机构。此外，在试验中使用的一些支架有限的可用性可能会限制这些result.Conclusion：CSEMSs的适用性有一个显着较长的通畅时间与USEMS相比，在远端恶性胆道梗阻患者。支架功能障碍的发生率相似，尽管CSEMSs有晚期梗阻的趋势。（Gastrointest Endosc 2011; 74：321 - 7.）
Background: Self-expandable metal stents (SEMSs) are used for palliation of malignant biliary obstruction.Objective: We performed a meta-analysis to compare stent patency and stent survival of covered SEMSs (CSEMSs) and uncovered SEMSs (USEMSs) in patients with unresectable distal malignant biliary obstruction.Design: Meta-analysis.Setting: Tertiary-care facility.Patients: A comprehensive search of several databases (from each database's earliest inclusive dates to November 2010, any language, and any population) was conducted. The search identified 337 potential abstracts and titles, of which 16 were retrieved in full text. Review of references identified 17 additional studies. We found 5 multicenter, randomized trials involving 781 patients.Intervention: Placement of covered and uncovered SEMSs for treatment of distal malignant biliary obstruction.Main Outcome Measurements: Stent patency, stent survival, patient survival, and cause for stent dysfunction (ingrowth, overgrowth, migration, and sludge formation).Results: The median length of follow-up was 212 days. Compared with USEMSs, CSEMSs were associated with significantly prolonged stent patency (weighted mean difference [WMD] 60.56 days; 95% confidence interval [CI], 25.96, 95.17; I-2 = 0%) and longer stent survival (WMD 68.87 days; 95% CI, 25.64, 112.11; I-2 = 79%). Stent migration, tumor overgrowth, and sludge formation were significantly higher with CSEMSs (relative risk [RR] 8.11; 95% CI, 1.47, 44.76; I-2 = 0%), (RR 2.02; 95% CI, 1.08, 3.78; I-2 = 0%), (RR 2.89; 95% CI, 1.27, 6.55; I-2 = 0%).Limitations: Relatively low number of studies available and the fact that 2 of the 5 studies were from one institution. Also, the limited availability of some stents used in the trials may limit the applicability of these results.Conclusion: CSEMSs have a significantly longer duration of patency compared with USEMSs in patients with distal malignant biliary obstruction. Stent dysfunction occurs at a similar rate, although there is a trend toward later obstruction with CSEMSs. (Gastrointest Endosc 2011;74:321-7.)