Hepaticogastrostomy versus hepaticogastrostomy with antegrade stenting for malignant biliary obstruction: a systematic review and meta-analysis.

IF 4.3 3区材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC

ACS Applied Electronic Materials Pub Date : 2024-10-08 eCollection Date: 2024-01-01 DOI:10.1177/17562848241273085

Panagiotis Paraskevopoulos, Mahmoud Obeidat, Dániel Bednárik, Petrana Martinekova, Dániel Sándor Veres, Nándor Faluhelyi, Alexandra Mikó, Péter Mátrai, Péter Hegyi, Bálint Erőss

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引用次数: 0

Abstract

Background: Combining antegrade stenting (AGS) and hepaticogastrostomy (HGS) is an increasingly used endoscopic ultrasound-guided intervention when stenting by endoscopic retrograde cholangiopancreatography is impossible.

Objectives: We comprehensively assessed the benefits and downsides of combined AGS and HGS (HGS procedure with AGS, HGAS).

Data sources and methods: From 788 HGS and 295 HGAS cases, a random-effects meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Five electronic databases were searched for studies on HGS with or without AGS from inception until May 2024. The odds ratio (OR) and pooled rates were used for single and two-arm comparisons with 95% confidence intervals (CI).

Results: From 26 eligible studies. The pooled technical and clinical success was 94% (CI: 92%-96%) and 88% (CI: 84%-91%) for HGS and 89% (CI: 83%-93%) and 94% (CI: 89%-97%) for HGAS, respectively. Pooled OR of HGAS and HGS showed an OR = 0.38 (CI: 0.07-2.00) for technical success and an OR = 1.02 (CI: 0.50-2.06) for clinical success. The pooled adverse event rates were 20% (CI: 16%-25%) for HGS and 14% (CI: 9%-20%) for HGAS, whereas pooled OR showed an OR = 1.09 (CI: 0.30-3.94). For re-intervention, an OR = 0.37 (CI: 0.27-0.52) was found. Time to stent dysfunction increased, HGAS 333 (CI: 280-Not reached) and HGS 209 (CI: 120-325) with no change in overall survival HGS 117 (CI: 94-147) and 140 (CI: 105-170).

Conclusion: The use of HGAS appears to increase clinical success and reduce the need for re-intervention. Overall adverse event rates were similar but bile leakage prevalence was decreased. Time to stent dysfunction seems to increase with no change in overall survival.

Trial registration: Our protocol was prospectively registered with PROSPERO (CRD42024509412).

查看原文本刊更多论文

肝胃造口术与肝胃造口术加前向支架治疗恶性胆道梗阻：系统综述与荟萃分析。

背景：当无法通过内镜逆行胰胆管造影术进行支架植入时，将前向支架植入术（AGS）和肝胃造瘘术（HGS）结合起来是一种越来越常用的内镜超声引导介入治疗方法：我们全面评估了联合 AGS 和 HGS（HGS 程序与 AGS，HGAS）的益处和弊端：根据《系统综述和荟萃分析首选报告项目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses）协议，我们对 788 例 HGS 和 295 例 HGAS 进行了随机效应荟萃分析。在五个电子数据库中搜索了从开始到 2024 年 5 月期间关于 HGS（伴有或不伴有 AGS）的研究。单臂和双臂比较使用的是几率比（OR）和汇总率，以及 95% 的置信区间（CI）：从 26 项符合条件的研究中HGS的汇总技术和临床成功率分别为94%（CI：92%-96%）和88%（CI：84%-91%），HGAS的汇总技术和临床成功率分别为89%（CI：83%-93%）和94%（CI：89%-97%）。HGAS 和 HGS 的汇总 OR 显示，技术成功率 OR = 0.38（CI：0.07-2.00），临床成功率 OR = 1.02（CI：0.50-2.06）。HGS和HGAS的不良事件汇总率分别为20%（CI：16%-25%）和14%（CI：9%-20%），而汇总OR显示OR=1.09（CI：0.30-3.94）。再次干预的OR=0.37（CI：0.27-0.52）。支架功能障碍时间延长，HGAS 333（CI：280-未达到），HGS 209（CI：120-325），而总生存期HGS 117（CI：94-147）和140（CI：105-170）没有变化：结论：使用 HGAS 似乎能提高临床成功率，减少再次干预的需要。总体不良事件发生率相似，但胆漏发生率有所下降。支架功能障碍的时间似乎增加了，但总生存率没有变化：我们的方案在PROSPERO（CRD42024509412）进行了前瞻性注册。

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

ACS Applied Electronic Materials Multiple-

CiteScore

7.20

自引率

4.30%

发文量

567