Endoscopic Bilateral Stent-in-Stent Versus Stent-by-Stent Deployment in Advanced Malignant Hilar Obstruction: A Meta-Analysis and Systematic Review
- Authors
- Shim,Sung Ryul; Lee, Tae Hoon; Yang, Jae Kook; Kim, Jae Heon; Lee, Yun Nah; Cha, Sang-Woo; Moon, Jong Ho; Cho, Young Deok; Park, Sang-Heum
- Issue Date
- Feb-2022
- Publisher
- Springer
- Keywords
- Bilateral; Hilar; Metal; Stent-by-stent; Stent-in-stent
- Citation
- Digestive Diseases and Sciences, v.67, no.2, pp 716 - 728
- Pages
- 13
- Indexed
- SCIE
SCOPUS
- Journal Title
- Digestive Diseases and Sciences
- Volume
- 67
- Number
- 2
- Start Page
- 716
- End Page
- 728
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/51972
- DOI
- 10.1007/s10620-021-06885-8
- ISSN
- 0163-2116
1573-2568
- Abstract
- Background and Aim
There is no clear data to compare the effectiveness and safety of bilateral stent-in-stent (SIS) or stent-by-stent (SBS) deployment for advanced malignant hilar obstruction (MHO). This meta-analysis was done to investigate clinical outcomes of these deployment methods.
Methods
We did a literature search to identify studies that reported the clinical outcomes of bilateral metal stents in patients with advanced MHO. Weighed pooled rates (WPR) along with 95% confidence interval (95% CI) were calculated in order to compare outcomes including technical and clinical success, adverse events, and stent occlusion between the two groups. We conducted a meta-analysis using a random-effects model.
Results
Five comparative studies with 250 patients, and 20 single-arm studies for the SIS or SBS method were eligible for the meta-analysis and systematic review. The bilateral SIS deployment had a significantly higher technical success rate than did SBS deployment (OR 6.43; 95% CI 1.08–38.09). There was no difference in the clinical success (OR 1.23; 95% CI 0.45–3.38), overall adverse events rates (OR 0.42; 95% CI 0.15–1.18), or overall occlusion rate (OR 1.55; 95% CI 0.89–2.70). As a single-armed group, WPR of technical success of the SIS and SBS groups was 96.4% and 89.6%, respectively. Clinical success was 97.5% and 98.3%. Overall, adverse events were 35.9% and 22.6%. Occlusion rates were 27.7% and 37.7%.
Conclusions
Although there was a lack of quality data and heterogeneity, bilateral SIS deployment had a higher technical feasibility than did the SBS method in patients with advanced MHO, without differences in terms of clinical success, adverse events, or occlusion rates.
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Collections - 3. Graduate School > Graduate School of Public Health > 1. Journal Articles
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