Percutaneous transhepatic and endoscopic biliary drainage for malignant biliary tract obstruction: a meta-analysis
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RESEARCH
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Percutaneous transhepatic and endoscopic biliary drainage for malignant biliary tract obstruction: a meta-analysis Jian-jun Leng1†, Ning Zhang1,2† and Jia-hong Dong1*
Abstract Background: Various malignant tumors can obstruct the extrahepatic biliary tract. Two major techniques for restoring bile flow in this circumstance are endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD).We conducted a meta-analysis to compare the effectiveness and safety of the two techniques. Methods: Medline, EMBASE and the Cochrane Library database were searched for articles published between January 1980 and December 2013. The outcome measures were therapeutic success rate (primary), 30-day mortality rate and overall complications. Results: Of 264 screened articles, 3 randomized controlled trials comprising an aggregate total of 183 cancer patients were included in the meta-analysis. Our analysis showed no significant difference in restoration of bile flow between patients treated with EBD and those treated with PTBD (odds ratio (OR) = 2.34, 95% confidence interval (CI) = 0.32 to 17.16, P = 0.401). However, the result of sensitivity analysis indicated that the study conducted by Speer et al. influenced the pooled estimates. After the Speer et al. study was excluded, the therapeutic success rate of patients treated with PTBD was significantly greater than that of those who underwent EBD (OR = 5.48, 95% CI: 2.26 to 13.28, P < 0.001). The 30-day mortality and complication rates were similar in the EBD and PTBD groups. Conclusions: The results of our meta-analysis indicate that PTBD had a higher therapeutic success rate than EBD in the treatment of malignancy-induced biliary obstruction. The mortality and complication rates of the two techniques were similar. Keywords: Biliary tract neoplasms, Biliary tract surgical procedures, Cholangiocarcinoma, Endoscopic biliary drainage, Extrahepatic biliary ducts, Malignancy-induced biliary obstruction, Obstructive jaundice, Percutaneous transhepatic biliary drainage
Background Malignant tumors that obstruct bile flow usually carry a very poor prognosis [1]. Tumor-induced obstructive jaundice can be caused by Klatskin tumors (hilar cholangiocarcinoma), pancreatic adenocarcinoma, gallbladder carcinoma, metastases in theporta hepatis lymph nodes, distal cholangiocarcinoma orhepatocellular carcinoma (HCC) [2-5]. Jaundice occurs in 5% to 44% of patients withHCC [3]. Symptoms include jaundice and pruritus, which can significantly impair patients’ quality of life. The * Correspondence: [email protected] † Equal contributors 1 Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China Full list of author information is available at the end of the article
major goal of palliative treatment for obstructing biliary tumors is the restoration of bile flow to the intestine [1]. Median survival has been found to be significantly longer in patients with restored bile drainage (
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