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Ophthalmic adverse drug reactions:A nationwide detection using hospital databases

World Journal of Meta-Analysis 2013年第2期1卷 78-82页

作者： Ana Miguel Filipe Henriques bernardo marques Joana marques Alberto Freitas Fernando Lopes Luís Azevedo Altamiro Costa Pereira Centre for Research in Health Technologies and Information Systems Faculty of Medicine University of Porto Department of Ophthalmology Central University Hospital of Coimbra Northern Pharmacovigilance Centre Faculty of Medicine University of Porto

AIM: To detect ophthalmic adverse drug reactions(ADRs), that occurred in Portugal from 2000 to 2009, through the utilization of administrative hospital databases. We also intended to compare the results of this methodology with spontaneous ***: We conducted a retrospective nationwide study using hospital administrative databases, which included all inpatients and outpatients in all public hospitals in Portugal, from 2000 to 2009. We used International Classification of Diseases- 9th Revision- Clinical Modification(ICD-9-CM) coding data that allowed the detection of ADRs. We used WHO's definition for ADR. We searched all of ICD-9-CM terms in Ophthalmology for codes that included "drug-induced", "iatrogenic", "toxic" and all other that could signal an ADR, such as "362.55- toxic maculopathy" or "365.03- steroid responders", and also "E" codes(codes from E930 to E949.9, that exclude intoxications and errors).RESULTS: From 11944725 hospitalizations or ambulatory episodes within that period of time, we identified 1524 probable ophthalmic ADRs(corresponding to a frequency of 1.28 per 10000 episodes) and an additional 100 possible ophthalmic ADRs. We used only 4 person-hours in the application of this methodology. A total of 113 spontaneous reports arose from ophthalmic ADRs from 2000 to 2009 in Portugal(frequency of 0.095 per 10000 episodes).To our knowledge, this was the first estimate of the frequency of ophthalmic ADRs through the use of databases, and the first nationwide estimate of ophthalmic ADRs, in Portugal. We identified 1524 probable ADRs and 100 possible ADRs. CONCLUSION: This database methodology adapted for Ophthalmology may represent a new approach for the detection of ophthalmic ADRs, since these codes exist in the ICD-9-CM classification. Its performance was clearly superior to spontaneous reporting.

关键词： Adverse drug reactions Ophthalmology Ocular Databases Pharmacovigilance

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Effects of intragastric balloon placement in metabolic dysfunctionassociated fatty liver disease: A systematic review and metaanalysis

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World Journal of Hepatology 2021年第7期13卷 815-829页

作者： João Remíde Freitas Júnior Igor Braga Ribeiro Diogo Turiani Hourneaux de Moura Vitor Massaro Takamatsu Sagae Gabriel Mayo Vieira de Souza Guilherme Henrique Peixoto de Oliveira Sergio A Sánchez-Luna Thiago Ferreira de Souza Eduardo Turiani Hourneaux de Moura Cláudia Pinto marques Souza de Oliveira Wanderley marques bernardo Eduardo Guimarães Hourneaux de Moura Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP Departamento de GastroenterologiaFaculdade de MedicinaUniversidade de Sao PauloSao PauloSPBR Division of Gastroenterology and Hepatology Department of Internal MedicineBasil I.Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at BirminghamBirminghamAL 35294United States Department of Gastroenterology Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil

BACKGROUND Metabolic dysfunction-associated fatty liver disease corresponds to a clinical entity that affects liver function triggered by the accumulation of fat in the liver and is linked with metabolic *** To evaluate the effects of the intragastric balloon(IGB)in patients with metabolic dysfunction-associated fatty liver disease through the assessment of liver enzymes,imaging and several metabolic *** A comprehensive search was done of multiple electronic databases(MEDLINE,EMBASE,LILACS,Cochrane and Google Scholar)and grey literature from their inception until February *** criteria involved patients with a body mass index>25 kg/m2 with evidence or previous diagnosis of hepatic *** analyzed before and after 6 mo of IGB removal were alanine aminotransferase(IU/L),gamma-glutamyltransferase(IU/L),glycated hemoglobin(%),triglycerides(mg/dL),systolic blood pressure(mmHg),homeostatic model assessment,abdominal circumference(cm),body mass index(kg/m2)and liver volume(cm3).RESULTS Ten retrospective cohort studies evaluating a total of 508 patients were *** 6 mo of IGB placement,this significantly reduced alanine aminotransferase[mean difference(MD):10.2,95%confidence interval(CI):8.12-12.3],gammaglutamyltransferase(MD:9.41,95%CI:6.94-11.88),glycated hemoglobin(MD:0.17%,95%CI:0.03-0.31),triglycerides(MD:38.58,95%CI:26.65-50.51),systolic pressure(MD:7.27,95%CI:4.79-9.76),homeostatic model assessment(MD:2.23%,95%CI:1.41-3.04),abdominal circumference(MD:12.12,95%CI:9.82-14.41)and body mass index(MD:5.07,95%CI:4.21-5.94).CONCLUSION IGB placement showed significant efficacy in improving alanine aminotransferase and gamma-glutamyltransferase levels in patients with metabolic dysfunctionassociated fatty liver disease as well as improving metabolic markers related to disease progression.

关键词： Intragastric balloon Metabolic dysfunction-associated fatty liver disease Homeostatic model assessment Abdominal circumference Body mass index

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Biliary drainage in inoperable malignant biliary distal obstruction: A systematic review and meta-analysis

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World Journal of Gastrointestinal Surgery 2021年第5期13卷 493-506页

作者： Maria Vitória Cury Vieira Scatimburgo Igor Braga Ribeiro Diogo Turiani Hourneaux de Moura Vitor Massaro Takamatsu Sagae Bruno Salomão Hirsch Mateus Bond Boghossian Thomas R McCarty Marcos EduardoLera dos Santos Tomazo Antonio Prince Franzini Wanderley marques bernardo Eduardo GuimarãesHourneaux de Moura Gastrointestinal Endoscopy Unit Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil Division of Gasteoenterology Hepatology and EndoscopyBrigham and Women's HospitalBostonMA 02115United States

BACKGROUND Endoscopic drainage remains the treatment of choice for unresectable or inoperable malignant distal biliary obstruction(MDBO).AIM To compare the safety and efficacy of plastic stent(PS)vs self-expanding metal stent(SEMS)placement for treatment of *** This meta-analysis was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.A comprehensive search was performed in MEDLINE,Cochrane,Embase,Latin American and Caribbean Health Sciences Literature,and grey literature to identify randomized clinical trials(RCTs)comparing clinical success,adverse events,stent dysfunction rate,reintervention rate,duration of stent patency,and mean *** difference(RD)and mean difference(MD)were calculated and heterogeneity was assessed with I2 *** analyses were performed by SEMS *** Twelve RCTs were included in this study,totaling 1005 *** was no difference in clinical success(RD=-0.03,95%confidence interval[CI]:-0.01,0.07;I 2=0%),rate of adverse events(RD=-0.03,95%CI:-0.10,0.03;I2=57%),and mean patient survival(MD=-0.63,95%CI:-18.07,19.33;I2=54%)between SEMS vs PS ***,SEMS placement was associated with a lower rate of reintervention(RD=-0.34,95%CI:-0.46,-0.22;I2=57%)and longer duration of stent patency(MD=125.77 d,95%CI:77.5,174.01).Subgroup analyses revealed both covered and uncovered SEMS improved stent patency compared to PS(RD=152.25,95%CI:37.42,267.07;I2=98%and RD=101.5,95%CI:38.91,164.09;I2=98%;respectively).Stent dysfunction was higher in the covered SEMS group(RD=-0.21,95%CI:-0.32,-0.1;I²=205%),with no difference in the uncovered SEMS group(RD=-0.08,95%CI:-0.56,0.39;I²=87%).CONCLUSION While both stent types possessed a similar clinical success rate,complication rate,and patient-associated mean survival for treatment of MDBO,SEMS were associated with a longer duration of stent patency compared to PS.

关键词： Biliary tract neoplasms Stents Protheses Malignancy Biliary system Cancer

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Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding:A systematic review and metaanalysis

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World Journal of Gastrointestinal Endoscopy 2018年第12期10卷 400-421页

作者： Hélcio Pedrosa Brito Igor Braga Ribeiro Diogo Turiani Hourneaux de Moura Wanderley marques bernardo Dalton marques Chaves Rogério Kuga Ethan Dwane Maahs Robson Kiyoshi Ishida Eduardo Turiani Hourneaux de Moura Eduardo Guimaraes Hourneaux de Moura Department of Endoscopy of Clinics Hospital of Sao Paulo University Sao Paulo 05403-00Brazil Molecular and Cell Biology University of CaliforniaCaliforniaBerkeleyCA 94720United States

AIM To compare the diagnostic accuracy of video capsule endoscopy(VCE) and double-balloon enteroscopy(DBE) in cases of obscure gastrointestinal bleeding(OGIB) of vascular *** MEDLINE(via PubMed), LILACS(via BVS) and Cochrane/CENTRAL virtual databases were searched for studies dated before 2017. We identified prospective and retrospective studies, including observational, cohort, single-blinded and multicenter studies, comparing VCE and DBE for the diagnosis of OGIB, and data of all the vascular sources of bleeding were collected. All patients were subjected to the same gold standard method. Relevant data were then extracted from each included study using a standardized extraction form. We calculated study variables(sensitivity, specificity, prevalence, positive and negative predictive values and accuracy) and performed a meta-analysis using Meta-Disc *** In the per-patient analysis, 17 studies(1477 lesions) were included. We identified3150 exams(1722 VCE and 1428 DBE) in 2043 patients and identified 2248 sources of bleeding, 1467 of which were from vascular lesions. Of these lesions, 864(58.5%) were diagnosed by VCE, and 613(41.5%) were diagnosed by DBE. The pretest probability for bleeding of vascular origin was 54.34%. The sensitivity of DBE was 84%(95%CI: 0.82-0.86; heterogeneity: 78.00%), and the specificity was92%(95%CI: 0.89-0.94; heterogeneity: 92.0%). For DBE, the positive likelihood ratio was 11.29(95%CI: 4.83-26.40; heterogeneity: 91.6%), and the negative likelihood ratio was 0.20(95%CI: 0.15-0.27; heterogeneity: 67.3%). Performing DBE after CE increased the diagnostic yield of vascular lesion by 7%, from 83% to90%.CONCLUSION The diagnostic accuracy of detecting small bowel bleeding from a vascular source is increased with the use of an isolated video capsule endoscope compared with isolated DBE. However, concomitant use increases the detection rate of the bleeding source.

关键词： Small bowel bleeding Hemorrhage Upper gastrointestinal bleeding Obscure hemorrhage Enteroscopy

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Treatment of high-grade dysplasia and intramucosal carcinoma using radiofrequency ablation or endoscopic mucosal resection + radiofrequency ablation: Meta-analysis and systematic review

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World Journal of Gastrointestinal Endoscopy 2019年第3期11卷 239-248页

作者： Mileine Valente de Matos Alberto Machado da Ponte-Neto Diogo Turiani Hourneaux de Moura Ethan Dwane Maahs Dalton marques Chaves Elisa Ryoka Baba Edson Ide Rubens Sallum Wanderley marques bernardo Eduardo Guimar?es Hourneaux de Moura Gastrointestinal Endoscopy Unit Gastroenterology Department University of Sao Paulo School of Medicine Genetics Genomics and Development (Molecular and Cell Biology)Department University of California Berkeley Gastrointestinal Surgery Gastroenterology Department University of Sao Paulo School of Medicine Thoracic Surgery Department Instituto do Coracao (InCorHeart Institute) University of Sao Paulo School of Medicine

BACKGROUND The progression of Barrett's esophagus(BE) to early esophageal carcinoma occurs sequentially; the metaplastic epithelium develops from a low-grade dysplasia to a high-grade dysplasia(HGD), resulting in early esophageal carcinoma and,eventually, invasive carcinoma. Endoscopic approaches including resection and ablation can be used in the treatment of this *** To compare the effectiveness of radiofrequency ablation(RFA) vs endoscopic mucosal resection(EMR) + RFA in the endoscopic treatment of HGD and intramucosal *** In accordance with PRISMA guidelines, this systematic review included studies comparing the two endoscopic techniques(EMR + RFA and RFA alone) in the treatment of HGD and intramucosal carcinoma in patients with BE. Our analysis included studies involving adult patients of any age with BE with HGD or intramucosal carcinoma. The studies compared RFA and EMR + RFA methods were included regardless of randomization *** The seven studies included in this review represent a total of 1950 patients, with742 in the EMR + RFA group and 1208 in the RFA alone group. The use of EMR +RFA was significantly more effective in the treatment of HGD [RD 0.35(0.15,0.56)] than was the use of RFA alone. The evaluated complications(stenosis,bleeding, and thoracic pain) were not significantly different between the two *** Endoscopic resection in combination with RFA is a safe and effective method in the treatment of HGD and intramucosal carcinoma, with higher rates of remission and no significant differences in complication rates when compared to the use of RFA alone.

关键词： Barrett esophagus Radiofrequency Endoscopic mucosal resection HALO system

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Propofol vs traditional sedatives for sedation in endoscopy:A systematic review and meta-analysis

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World Journal of Gastrointestinal Endoscopy 2019年第12期11卷 573-588页

作者： Aureo Augusto de Almeida Delgado Diogo Turiani Hourneaux de Moura Igor Braga Ribeiro Ahmad Najdat Bazarbashi Marcos Eduardo Lera dos Santos Wanderley marques bernardo Eduardo Guimaraes Hourneaux de Moura Gastrointestinal Endoscopy Unit Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao PauloSao Paulo 05403000Brazil Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s HospitalHarvard Medical SchoolBostonMA 02115United States

BACKGROUND Propofol is commonly used for sedation during endoscopic *** suggests its superiority to traditional sedatives used in endoscopy including benzodiazepines and opioids with more rapid onset of action and improved postprocedure recovery times for ***,Propofol requires administration by trained healthcare providers,has a narrow therapeutic index,lacks an antidote and increases risks of cardio-pulmonary *** To compare,through a systematic review of the literature and meta-analysis,sedation with propofol to traditional sedatives with or without propofol during endoscopic *** A literature search was performed using MEDLINE,Scopus,EMBASE,the Cochrane Library,Scopus,LILACS,BVS,Cochrane Central Register of Controlled Trials,and The Cumulative Index to Nursing and Allied Health Literature *** last search in the literature was performed on March,2019 with no restriction regarding the idiom or the year of *** randomized clinical trials with full texts published were *** divided sedation therapies to the following groups:(1)Propofol versus benzodiazepines and/or opiate sedatives;(2)Propofol versus Propofol with benzodiazepine and/or opioids;and(3)Propofol with adjunctive benzodiazepine and opioid versus benzodiazepine and *** following outcomes were addressed:Adverse events,patient satisfaction with type of sedation,endoscopists satisfaction with sedation administered,dose of propofol administered and time to recovery post ***-analysis was performed using RevMan5 software version *** A total of 23 clinical trials were included(n=3854)from the initial search of 6410 *** Group I(Propofol vs benzodiazepine and/or opioids):The incidence of bradycardia was not statistically different between both sedation arms(RD:-0.01,95%CI:-0.03–+0.01,I2:22%).In 10 studies,the incidence of hypotension was not statistically difference between sedation arms(RD:0.01,95%CI

关键词： Sedation Digestive endoscopy Propofol Benzodiazepines Opioids Adverse events

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Endoscopic retrograde cholangiopancreatography drainage for palliation of malignant hilar biliary obstruction——stent-in-stent or side-by-side?A systematic review and meta-analysis

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World Journal of Hepatology 2021年第5期13卷 595-610页

作者： Gabriel Mayo Vieira de Souza Igor Braga Ribeiro Mateus Pereira Funari Diogo Turiani Hourneaux de Moura Maria Vitória Cury Vieira Scatimburgo João Remíde Freitas Júnior Sergio A Sánchez-Luna Renato Baracat Eduardo Turiani Hourneaux de Moura Wanderley marques bernardo Eduardo Guimarães Hourneaux de Moura Gastrointestinal Endoscopy Unit Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil Division of Gastroenterology Hepatology and NutritionCenter for Advanced Therapeutic EndoscopyAllegheny Health NetworkPittsburghPA 15212United States Division of Gastroenterology and Hepatology Department of Internal MedicineBasil I.Hirschowitz Endoscopic Center of ExcellenceBirminghamAL 35294United States

BACKGROUND Biliary drainage,either by the stent-in-stent(SIS)or side-by-side(SBS)technique,is often required when treating a malignant hilar biliary obstruction(MHBO).Both methods differ from each other and have distinct *** To compare both techniques regarding their efficacy and safety in achieving drainage of *** A comprehensive search of multiple electronic databases(MEDLINE,Embase,LILACS,BIREME,Cochrane)was conducted and grey literature from their inception until December 2020 with no restrictions regarding the year of publication or language,since there was at least an abstract in *** included studies compared SIS and SBS techniques through endoscopic retrograde *** analyzed included technical and clinical success,early and late adverse events(AEs),stent patency,reintervention,and procedure-related *** Four cohort studies and one randomized controlled trial evaluating a total of 250 patients(127 in the SIS group and 123 in the SBS group)were included in this *** were no statistically significant differences between the two groups concerning the evaluated outcomes,except for stent patency,which was higher in the SIS compared with the SBS technique[mean difference(d)=33.31;95%confidence interval:9.73 to 56.90,I2=45%,P=0.006].CONCLUSION The SIS method showed superior stent patency when compared to SBS for achieving bilateral drainage in *** techniques are equivalent in terms of technical success,clinical success,rates of both early and late AEs,reintervention,and procedure-related mortality.

关键词： Endoscopic retrograde cholangiopancreatography Biliary tract neoplasms Biliary Hilar Stenting Drainage

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Propofol vs midazolam sedation for elective endoscopy in patients with cirrhosis:A systematic review and meta-analysis of randomized controlled trials

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World Journal of Gastrointestinal Endoscopy 2020年第8期12卷 241-255页

作者： John Alexander Lata Guacho Diogo Turiani Hourneaux de Moura Igor Braga Ribeiro Alberto Machado da Ponte Neto Shailendra Singh Marina Gammaro Baldavira Tucci Wanderley marques bernardo Eduardo Guimarães Hourneaux de Moura Gastrointestinal Endoscopy Unit Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 05403-010Brazil Division of Gastroenterology Department of Internal MedicineWest Virginia UniversityCharlestonWV 25304United States

BACKGROUND Patients with cirrhosis frequently require sedation for elective endoscopic *** sedation protocols are available,but choosing an appropriate sedative in patients with cirrhosis is *** To conduct a systematic review and meta-analysis to compare propofol and midazolam for sedation in patients with cirrhosis during elective endoscopic procedures in an attempt to understand the best *** This systematic review and meta-analysis was conducted using the PRISMA *** searches were performed using MEDLINE,EMBASE,Central Cochrane,LILACS *** randomized control trials(RCTs)were *** outcomes studied were procedure time,recovery time,discharge time,and adverse events(bradycardia,hypotension,and hypoxemia).The risk of bias assessment was performed using the Revised Cochrane Risk-of-Bias tool for randomized trials(RoB-2).Quality of evidence was evaluated by *** meta-analysis was performed using Review *** The search yielded 3,576 *** of these,8 RCTs with a total of 596 patients(302 in the propofol group and 294 in the midazolam group)were included for the final *** time was similar between midazolam and propofol groups(MD:0.25,95%CI:-0.64 to 1.13,P=0.59).Recovery time(MD:-8.19,95%CI:-10.59 to-5.79,P<0.00001).and discharge time were significantly less in the propofol group(MD:-12.98,95%CI:-18.46 to-7.50,P<0.00001).Adverse events were similar in both groups(RD:0.02,95%CI:0-0.04,P=0.58).Moreover,no significant difference was found for bradycardia(RD:0.03,95%CI:-0.01 to 0.07,P=0.16),hypotension(RD:0.03,95%CI:-0.01 to 0.07,P=0.17),and hypoxemia(RD:0.00,95%CI:-0.04 to 0.04,P=0.93).Five studies had low risk of bias,two demonstrated some concerns,and one presented high *** quality of the evidence was very low for procedure time,recovery time,and adverse events;while low for discharge *** This systematic review and meta-analysis based on RCTs sh

关键词： Sedation Midazolam Propofol Cirrhosis Endoscopic Endoscopy Metaanalysis

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Endoscopy vs surgery in the treatment of early gastric cancer:Systematic review

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World Journal of Gastroenterology 2015年第46期21卷 13177-13187页

作者： André Kondo Eduardo Guimaraes Hourneaux de Moura Wanderley marques bernardo Osmar Kenji Yagi Diogo Turiani Hourneaux de Moura Eduardo Turiani Hourneaux de Moura José Gon?alves Pereira Bravo Kendi Yamazaki Paulo Sakai Gastrointestinal Endoscopy Division Department of GastroenterologyHospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo Guidelines Program Coordinator Brazilian Medical Association (AMB) Gastrointestinal Surgery Division Sao Paulo State Cancer Institute (ICESP)Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo

AIM: To report a systematic review,establishing the available data to an unpublished 2a strength of evidence,better handling clinical ***: A systematic review was performed using MEDLINE,EMBASE,Cochrane,LILACS,Scopus and CINAHL databases. Information of the selected studies was extracted on characteristics of trial participants,inclusion and exclusion criteria,interventions(mainly,mucosal resection and submucosal dissection vs surgical approach) and outcomes(adverse events,different survival rates,mortality,recurrence and complete resection rates). To ascertain the validity of eligible studies,the risk of bias was measured using the Newcastle-Ottawa Quality Assessment Scale. The analysis of the absolute risk of the outcomes was performed using the software Rev Man,by computingrisk differences(RD) of dichotomous variables. Data on RD and 95%CIs for each outcome were calculated using the Mantel-Haenszel test and inconsistency was qualified and reported in χ2 and the Higgins method(I2). Sensitivity analysis was performed when heterogeneity was higher than 50%,a subsequent assay was done and other findings were ***: Eleven retrospective cohort studies were selected. The included records involved 2654 patients with early gastric cancer that filled the absolute or expanded indications for endoscopic resection. Threeyear survival data were available for six studies(n = 1197). There were no risk differences(RD) after endoscopic and surgical treatment(RD = 0.01,95%CI:-0.02-0.05,P = 0.51). Five-year survival data(n = 2310) showed no difference between the two groups(RD = 0.01,95%CI:-0.01-0.03,P = 0.46). Recurrence data were analized in five studies(1331 patients) and there was no difference between the approaches(RD = 0.01,95%CI:-0.00-0.02,P = 0.09). Adverse event data were identified in eight studies(n = 2439). A significant difference was detected(RD =-0.08,95%CI:-0.10--0.05,P < 0.05),demonstrating better results with endoscopy. Mortality data were

关键词： Gastric cancer Endoscopy Gastroscopy Gastrectomy Surgery Systematic review

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Endoscopic stenting for inoperable malignant biliary obstruction: A systematic review and meta-analysis

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World Journal of Gastroenterology 2015年第47期21卷 13374-13385页

作者： Leonardo Zorrón Pu Eduardo Guimaraes Hourneaux de Moura Wanderley marques bernardo Felipe Iankelevich Baracat Ernesto Quaresma Mendonca AndréKondo Gustavo Oliveira Luz Carlos Kiyoshi Furuya Júnior Everson Luiz de Almeida Artifon Gastrointestinal Endoscopy Division Department of GastroenterologyHospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo Guidelines Program Coordinator Brazilian Medical Association

AIM: To analyze through meta-analyses the benefits of two types of stents in the inoperable malignant biliary ***: A systematic review of randomized clinical trials(RCT) was conducted, with the last update on March 2015, using EMBASE, CINAHL(EBSCO), MEDLINE, LILACS/CENTRAL(BVS), SCOPUS, CAPES(Brazil), and gray literature. Information of the selected studies was extracted in sight of six outcomes: primarily regarding dysfunction, complication and reintervention rates; and secondarily costs, survival, and patency time. The data about characteristics of trial participants, inclusion and exclusion criteria and types of stents were also extracted. The bias was mainly assessed through the JADAD scale. This meta-analysis was registered in the PROSPERO database by the number CRD42014015078. The analysis of the absolute risk of the outcomes was performed using the software Rev Man, by computing risk differences(RD) of dichotomous variables and mean differences(MD) of continuous variables. Data on RD and MD for each primary outcome were calculated using the MantelHaenszel test and inconsistency was qualified and reported in χ2 and the Higgins method(I2). Sensitivity analysis was performed when heterogeneity was higher than 50%, a subsequent assay was done and other findings were compiled. Student's t-test was used for the comparison of weighted arithmetic means regarding secondary ***: Initial searching identified 3660 studies; 3539 were excluded through title, repetition, and/or abstract, while 121 studies were fully assessed and were excluded mainly because they did not compare self-expanding metal stents(SEMS) and plastic stents(PS), leading to thirteen RCT selected, with 13 articles and 1133 subjects meta-analyzed. The mean age was 69.5 years old, that were affected mostly by bile duct(proximal) and pancreatic tumors(distal). The preferred SEMS diameter used was the 10 mm(30 Fr) and the preferred PS diameter used was 10 Fr. In the metaanalysis

关键词： Biliary tract neoplasms Malignant biliaryobstruction Jaundice Palliative care Endoscopicretrograde cholangiopancreatography Stent Systematicreview Meta-analysis

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