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Saudi J Gastroenterol. 2019 Feb 1. doi: 10.4103/sjg.SJG_429_18. [Epub ahead of print]

Comparison of long-term efficacy between endoscopic and percutaneous biliary drainage for resectable extrahepatic cholangiocarcinoma with biliary obstruction: A systematic review and meta-analysis.

Author information

1
Department of Radiation Oncology; The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China.
2
The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province; Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University; Liver Diseases Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
3
Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University; Liver Diseases Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
4
The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University; Liver Diseases Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.

Abstract

Background/Aim:

For resectable extrahepatic cholangiocarcinoma with biliary obstruction, it remains a controversy whether to choose percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD). A systematic review was conducted to compare the long-term efficacy between the two techniques.

Materials and Methods:

Eligible studies were searched from January 1990 to May 2018, comparing the long-term efficacy between EBD and PTBD for extrahepatic cholangiocarcinoma. Primary end point was overall survival (OS) rate, and secondary end points included postoperative severe complications and seeding metastasis. Effect size on outcomes was calculated using a fixed- or random-effect model, accompanied with hazard ratio (HR) and 95% confidence interval (CI).

Result:

Six studies were included in this meta-analysis. Meta-analysis showed that EBD was superior to PTBD in OS (HR = 0.70, 95% CI 0.59-0.84,P= 0.0002). But subgroup results showed that the superiority disappeared in distal cholangiocarcinoma (HR = 0.76, 95% CI 0.56-1.01,P= 0.06). Other prognostic factors such as intraoperative blood transfusion, lymphatic metastasis and seeding metastasis, were inconsistent between groups. In addition, regional disparity was obviously apparent between Japanese and non-Japanese studies.

Conclusion:

The conclusion that EBD was superior to PTBD in OS for resectable extrahepatic cholangiocarcinoma with biliary obstruction is less convincing, and more trials need to be conducted in future.

KEYWORDS:

Endoscope biliary drainage; extrahepatic cholangiocarcinoma; meta-analysis; overall survival; percutaneous biliary drainage; preoperative biliary drainage

PMID:
30720001
DOI:
10.4103/sjg.SJG_429_18
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