Abstract
BackgroundVarious 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.MethodsMedline, 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.ResultsOf 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.ConclusionsThe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/1477-7819-12-272) contains supplementary material, which is available to authorized users.
Highlights
Various malignant tumors can obstruct the extrahepatic biliary tract
Tumor-induced obstructive jaundice can be caused by Klatskin tumors, pancreatic adenocarcinoma, gallbladder carcinoma, metastases in theporta hepatis lymph nodes, distal cholangiocarcinoma orhepatocellular carcinoma (HCC) [2,3,4,5]
The results indicated that the study conducted by Speer et al [12] influenced the pooled estimates. After those results were excluded, the heterogeneity was substantially decreased (Q = 1.75, I2 = 42.88%, P = 0.186), and the results indicated that the percutaneous transhepatic biliary drainage (PTBD) group had a significantly higher therapeutic success rate than did the endoscopic biliary drainage (EBD) group (OR = 5.48, 95% confidence intervals (CIs) = 2.26 to 13.28, P < 0.001) (Figure 3C)
Summary
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. The. Treatment modalities that can restore adequate bile duct drainage in malignant biliary obstruction cases include surgical biliary bypass, endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15]. Treatment modalities that can restore adequate bile duct drainage in malignant biliary obstruction cases include surgical biliary bypass, endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15] None of these procedures has been proven superior to the others, and the most effective procedure for decompression of bile obstruction remains controversial. Cholangitis and pancreatitis are common complications of all the biliary decompression procedures [8]
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