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Endoscopic palliative treatment versus surgical bypass in malignant low bile duct obstruction: A systematic review and meta-analysis
並列摘要
Aims: Despite technological advances, only about 20% of periampullary tumors are found to be resectable at the time of presentation. Biliary tree obstruction and consequent jaundice occur in 70-90% of those patients and has important consequences for a patient's quality of life. Relief of biliary tree obstruction is the main goal for treatment, and few options for palliative therapy of biliary tree obstruction can be performed, including surgical bypass, percutaneous stenting, and endoscopic stenting. Objective: The aim of the present study was to acquire and analyze data to compare the success of procedures, procedure-related complication, mortality in 30 days, recurrent-jaundice rates in endoscopic, and surgical palliative techniques. Methods: Two independent reviewers searched the following electronic databases: Medline, EMBASE, Cochrane, LILACS, BVS, SCOPE, and CINAHL (EBSCO). Inclusion criteria included studies involving patients with distal biliary obstruction due to periampullary tumors who underwent endoscopic therapy or a surgical procedure for palliation. Results: No differences were observed for success of procedures; differences were observed with better outcomes for endoscopy therapy with regards to mortality associated with procedure, complication associated with procedure, and mortality in 30 days. Also, differences were observed with better outcomes for surgery therapy for recurrent-jaundice. Conclusion: Endoscopic palliative drainage is associated with a lower rate in complication, mortality associated with procedure, and mortality in 30 days. Recurrent-jaundice analysis demonstrated an overall lower rate in surgical bypass procedures. No differences were found for the success of procedures.
延伸閱讀
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