Endoscopic Bilateral Drainage Techniques of Malignant Hilar Biliary Obstruction: Stent-In-Stent or Side-By-Side? A Systematic Review and Meta-Analysis

Aims Malignant biliary tract tumors are unresectable for up to 80 % of cases. Biliary drainage is often required when dealing with a malignant hilar biliary obstruction (MHBO). There are two types of drainage: stent-in-stent (SIS) and side-by-side (SBS), which differ from each other and have distinct advantages. The aim of this meta-analysis was to compare both techniques regarding efficacy and safety.

Methods This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) recommendations. We searched through MEDLINE, EMBASE, Cochrane CENTRAL, and Lilacs/Bireme databases with no restrictions regarding the year of publication or language. Evaluated outcomes concern technical success, bilirubin level decrease, early and late adverse events, stent patency, reintervention and procedure-related mortality. Quality of evidence was assessed for each outcome according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) software.

Results Four studies were included with a total number of 186 patients — 87 in the SIS group and 99 in the SBS group. There were no significant differences between groups concerning the evaluated outcomes ([table]), except for bilirubin level decrease, which benefited SIS over SBS (RD 0.13; 95 % CI [0.02 to 0.23] I² = 0 %, p = 0.02).

Tab. 1

Outcomes	Overall analysis	Outcomes	Overall analysis
Technical success	RD= 0.07; 95 % CI [−0.01 to 0.15], I2 = 0 %, p = 0,10	Stent patency	MD= 3,18; 95 % CI [−40.98 to 47.35], I2 = 15 %, p = 0,89
Bilirubin level decrease	RD 0.13; 95 % CI [0.02 to 0.23] I2 = 0 %, p = 0,02	Reintervention	RD= 0.05; 95 % CI [−0.15 to 0.26], I2 = 0 %, p = 0,60
Early adverse events	RD= -0.00; 95 % CI [−0.10 to 0.10], I2 = 0 %, p = 0,97	Procedure-related mortality	RD= 0.00; 95 % CI [−0.05 to 0.05], I2 = 0 %, p = 1,00
Late adverse events	RD= -0.05; 95 % CI [−0.16 to 0.07], I2 = 23 %, p = 0,42

Conclusions Stent-in-stent and side-by-side perform equivalently in terms of bilateral biliary drainage in malignant hilar biliary obstruction. Then, the best approach should be to consider both local expertise and resource availability.

Citation: de Souza GMV, Ribeiro IB, Funari MP et al. OP136 ENDOSCOPIC BILATERAL DRAINAGE TECHNIQUES OF MALIGNANT HILAR BILIARY OBSTRUCTION: STENT-IN-STENT OR SIDE-BY-SIDE? A SYSTEMATIC REVIEW AND META-ANALYSIS. Endoscopy 2021; 53: S56.

Publication History

Article published online:
19 March 2021