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

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 j.nior 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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