Efficacy and safety of covered self-expandable metal stents for malignant hilar biliary obstruction: systematic review and meta-analysis

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy Pub Date : 2025-02-01 DOI:10.1016/j.gie.2024.09.037

Kwang Hyun Chung MD , Kyong Joo Lee MD, PhD , Abel A. Joseph MD , Robert J. Huang MD , Andrew Li MD , Joo Ha Hwang MD, PhD , Seung Bae Yoon MD, PhD

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Abstract

Background and Aims

Covered self-expandable metal stents (CSEMSs) are used for malignant hilar biliary obstruction (MHBO) management. Despite increasing evidence, a comprehensive evaluation of the efficacy and safety of CSEMSs in MHBO management is lacking.

Methods

PubMed, EMBASE, and the Cochrane Library were screened up to March 31, 2024, for studies including MHBO treated by a CSEMS. Studies meeting predefined inclusion criteria, including adult MHBO patients treated with CSEMS placement, reporting technical success, clinical success, and adverse event rates were selected. Data synthesis and statistical analysis were performed using the random-effects model, with heterogeneity and publication bias assessment.

Results

From 401 articles, 7 studies were included. Pooled technical and clinical success rates of CSEMSs were 96.7% (95% confidence interval [CI], 92.6-98.6; I² = 0%) and 91.6% (95% CI, 86.1-95.0; I² = 0%). Overall adverse events were reported in 16.6% of cases (95% CI, 11.2-23.9; I² = 24%), which included cholangitis (7.4%), pancreatitis (5.9%), liver abscess (5.9%), and cholecystitis (2.8%). Stent migration and recurrent biliary obstruction (RBO) were observed in 8.9% and 49.6% of cases, respectively, with a median time to RBO of 142 days. Reintervention was successful in 92.5% of cases (95% CI, 83.1-96.9; I² = 0%).

Conclusions

Our meta-analysis revealed high technical and clinical success rates of CSEMS placement in MHBO. Adverse events, notably cholangitis, cholecystitis, and pancreatitis, were <10%. RBO and stent migration were mitigated by CSEMS removal and successful reintervention. Our findings highlight the efficacy and safety of CSEMSs in managing MHBO, warranting further research to optimize treatment strategies.

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有盖自膨式金属支架治疗恶性肝胆道梗阻的有效性和安全性：系统回顾和荟萃分析。

背景和目的：覆盖型自膨胀金属支架（C-SEMS）用于恶性肝胆管梗阻（MHBO）的治疗。尽管证据越来越多，但对 C-SEMS 在 MHBO 治疗中的有效性和安全性仍缺乏全面评估：方法：对 PubMed、EMBASE 和 Cochrane 图书馆截至 2024 年 3 月 31 日的研究进行筛选，其中包括使用 C-SEMS 治疗 MHBO 的研究。筛选出符合预定义纳入标准的研究，包括接受 C-SEMS 置入治疗的成年 MHBO 患者，报告技术成功率、临床成功率和不良事件发生率。采用随机效应模型进行数据综合和统计分析，并对异质性和发表偏倚进行评估：结果：从 401 篇文章中纳入了 7 项研究。C-SEMS的汇总技术和临床成功率分别为96.7%（95% CI 92.6-98.6%，I2=0%）和91.6%（95% CI 86.1-95.0%，I2=0%）。16.6%（95% CI 11.2-23.9%，I2=24%）的病例报告了总体不良事件，其中包括胆管炎（7.4%）、胰腺炎（5.9%）、肝脓肿（5.9%）和胆囊炎（2.8%）。分别有 8.9% 和 49.6% 的病例出现支架移位和复发性胆道梗阻，复发性胆道梗阻的中位时间为 142 天。92.5%的病例再介入成功（95% CI 83.1-96.9%，I2=0%）结论：我们的荟萃分析显示，C-SEMS 在 MHBO 中的技术和临床成功率很高。不良事件，尤其是胆管炎、胆囊炎和胰腺炎的发生率较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gastrointestinal endoscopy 医学-胃肠肝病学

CiteScore

10.30

自引率

7.80%

发文量

1441

审稿时长

38 days

期刊介绍： Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.