Biliary stenting with or without sphincterotomy for malignant biliary obstruction: a meta-analysis

Abstract

Aim: To investigate the benefits of endoscopic sphincterotomy (EST) before stent placement by meta-analysis of randomized controlled trials (RCTs).

Methods: PubMed, EMBASE, Cochrane Library, and Science Citation Index databases up to March 2014 were searched. The primary outcome was incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and successful stent insertion rate. The secondary outcomes were the incidence of post-ERCP bleeding, stent migration and occlusion. The free software Review Manager was used to perform the meta-analysis.

Results: Three studies (n = 338 patients, 170 in the EST group and 168 in the non-EST group) were included. All three studies described a comparison of baseline patient characteristics and showed that there were no statistically significant differences between the two groups. Three RCTs, including 338 patients, were included in this meta-analysis. Most of the analyzed outcomes were similar between the groups. Although EST reduced the incidence of PEP, it also led to a higher incidence of post-ERCP bleeding (OR = 0.34, 95%CI: 0.12-0.93, P = 0.04; OR = 9.70, 95%CI: 1.21-77.75, P = 0.03, respectively).

Conclusion: EST before stent placement may be useful in reducing the incidence of PEP. However, EST-related complications, such as bleeding and perforation, may offset this effect.

Keywords: Biliary stent; Endoscopic retrograde cholangiopancreatography; Endoscopic sphincterotomy; Malignant biliary obstruction.

Figures

Figure 1

Search protocol for the meta-analysis. RCT: Randomized controlled trial.

Figure 2

Forest plot. A: Comparison of the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) between the endoscopic sphincterotomy (EST) and non-EST groups; B: Comparison of the rate of successful stent insertion between the EST and non-EST groups; C: Comparison of the rate of post-ERCP bleeding between the EST and non-EST groups; D: Comparison of the rate of stent migration between the EST and non-EST groups; E: Comparison of the rate of stent occlusion between the EST and non-EST groups.