Meta-Analysis
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World J Gastroenterol. Oct 14, 2014; 20(38): 14033-14039
Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.14033
Biliary stenting with or without sphincterotomy for malignant biliary obstruction: A meta-analysis
Pei-Jing Cui, Jing Yao, Yi-Jun Zhao, Hua-Zhong Han, Jun Yang
Pei-Jing Cui, Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Jing Yao, Yi-Jun Zhao, Hua-Zhong Han, Jun Yang, Department of Surgery, Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
Author contributions: Cui PJ and Yao J contributed equally to this work; Yang J designed research; Cui PJ, Yao J and Han HZ performed the data search and meta-analysis; Zhao YJ and Yang J wrote the paper.
Correspondence to: Jun Yang, MD, PhD, Department of Surgery, Sixth People’s Hospital, Shanghai Jiao Tong University, Huashan Rd 1954, Shanghai 200233, China. yangjuns@foxmail.com
Telephone: +86-21-64369181 Fax: +86-21-6436892
Received: March 18, 2014
Revised: May 15, 2014
Accepted: June 14, 2014
Published online: October 14, 2014
Processing time: 211 Days and 21.5 Hours
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 sphincterotomy; Endoscopic retrograde cholangiopancreatography; Malignant biliary obstruction

Core tip: It is unclear whether patients with malignant biliary obstruction who receive stent placement benefit from endoscopic sphincterotomy (EST). The present meta-analysis was performed to investigate the clinical outcomes of patients who did and did not undergo EST before stent placement.