CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(01): E26-E35
DOI: 10.1055/a-0752-9956
Review
Owner and Copyright © Georg Thieme Verlag KG 2019

Endoscopic biliary self-expandable metallic stent in malignant biliary obstruction with or without sphincterotomy: systematic review and meta-analysis

Benedetto Mangiavillano
1   Gastrointestinal Endoscopy Unit; Humanitas – Mater Domini Castellanza, Italy
2   Humanitas University, Milan, Italy
,
Amedeo Montale
3   Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
,
Leonardo Frazzoni
3   Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
,
Mario Bianchetti
1   Gastrointestinal Endoscopy Unit; Humanitas – Mater Domini Castellanza, Italy
,
Amrita Sethi
4   New York-Presbyterian Medical Center/Columbia University Medical Center, New York, New York, United States
,
Alessandro Repici
2   Humanitas University, Milan, Italy
5   Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano (MI) Italy
,
Lorenzo Fuccio
3   Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
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Weitere Informationen

Publikationsverlauf

submitted 11. Mai 2018

accepted after revision 04. September 2018

Publikationsdatum:
03. Januar 2019 (online)

Abstract

Background and aim To assess the rate of adverse events and the technical success rate of biliary stenting with or without EBS. 

Methods A literature search up to February 2017 was performed. Studies assessing adverse events (AEs) and technical success rates of stenting with or without EBS were considered.

Results Seven studies (870 patients; 12 treatment arms) were included. Early AEs, i. e. those occurring within 30 days, were significantly lower in no-EBS vs. EBS-group (11 % vs. 20.1 %; OR: 0.36, 95 %CI: 0.13 – 1.00). Rates of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis were not significantly different in the two groups (no-EBS vs. EBS: 6.1 % vs 5 %; OR: 1.33, 95 %CI: 0.68 – 2.59). The rate of bleeding was significantly lower in patients without EBS (no-EBS vs EBS: 0 % vs 5 %; OR: 0.12, 95 % CI: 0.03 – 0.45). Rates of cholangitis were significantly lower in patients without EBS (no-EBS vs. EBS: 3.3 % vs. 7.4 %; OR: 0.38, 95 %CI: 0.17 – 0.83). Both late AEs and mortality rates did not significantly differ between no-EBS and EBS patients (19.9 % vs. 18.9 %; OR: 0.93, 95 %CI: 0.56 – 1.53, and 2.5 % vs. 2.9 %; OR: 1.18, 95 %CI: 0.22 – 6.29, respectively). The technical success rate for stent insertion also did not differ (98 % vs. 97.6 %; OR: 1.05, 95 %CI: 0.42 – 2.63).

Conclusion EBS seems to be associated, in the first 30 days after the procedure, with an increased risk of cholangitis and bleeding. No difference was observed in the rate of post-ERCP pancreatitis.

 
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