Unilateral versus bilateral endoscopic stenting in patients with unresectable malignant hilar obstruction: a systematic review and meta-analysis

Abstract Background and study aims Endoscopic stent placement is used for palliative management of unresectable malignant hilar obstruction, which could be achieved by either unilateral or bilateral stent insertion. Materials and methods A literature search was performed to identify studies that reported outcomes of metallic biliary stent placement in patients with malignant hilar obstruction. Weighted pooled rates (WPR) along with 95 % confidence intervals (95 %CI) were calculated to determine and compare outcomes including technical and functional success, early and late adverse events, post procedure cholangitis, and stent occlusion between two groups. Results A total of 21 studies with 1292 patients were included. WPR of technical success was significantly higher in the unilateral group (97 %, 95 %CI: 93 –98 %) vs. bilateral group (89 %, 95 %CI: 84 –92 %) (P = 0.0.003). WPR for functional success in the unilateral and bilateral groups were 96 % (95 %CI: 91 –98 %) and 94 % (95 %CI: 91 –97 %), respectively (P = 0.48). The rate of early and late complications was comparable between the two groups. Conclusion In patients with unresectable malignant hilar obstruction, unilateral and bilateral metallic stenting techniques are comparable in terms of efficacy and safety.

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Stent or Surgery for Malignant Low Bileduct Obstruction?

HPB Surgery ◽

10.1155/1997/21935 ◽

1997 ◽

Vol 10 (3) ◽

pp. 179-181

Author(s):

Ingemar Ihse ◽

Lars Hansson ◽

Lars-Erik Hammarström ◽

Eva Lindström

Keyword(s):

Controlled Trial ◽

Surgical Techniques ◽

Outlet Obstruction ◽

Major Complication ◽

Late Complications ◽

Stent Insertion ◽

Endoscopic Stenting ◽

Total Hospital Stay ◽

Significant Difference ◽

Cast Doubt

The development of non-surgical techniques for the relief of malignant low bileduct obstruction has cast doubt on the best way of relieving jaundice, particularly in patients fit for surgery whose life expectancy is more than a few weeks.We did a randomised prospective controlled trial comparing endoscopic stent insertion and surgical biliary bypass in patients with malignant low bileduct obstruction. 204 patients were randomised (surgery 103, stent 101); 3 subsequently proved to have benign disease and were excluded, leaving 101 surgical and 100 stented patients for assessment. Technical success was achieved in 94 surgical and 95 stent patients, with functional biliary decompression obtained in 92 patients in both groups. In stented patients, there was a lower procedure-related mortality (3% vs 14%, p=0.01), major complication rate (11% vs 29%, p=0.02), and median total hospital stay (20 vs 26 days, p=0.001). Recurrent jaundice occurred in 36 stented patients and 2 surgical patients. Late gastric outlet obstruction occurred in 17% of stented patients and 7% of the surgical group. Despite the early benefits of stenting there was no significant difference in overall survival between the two groups (median survival: surgical 26 weeks; stented 21 weeks; p=0.065).Endoscopic stenting and surgery are effective palliative treatments with the former having fewer early treatment-related complications and the latter fewer late complications.

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Preoperative endoscopic stent placement before pancreaticoduodenectomy: A meta-analysis of the effect on morbidity and mortality

Gastrointestinal Endoscopy ◽

10.1067/mge.2002.128161 ◽

2002 ◽

Vol 56 (4) ◽

pp. 529-534 ◽

Cited By ~ 1

Author(s):

Martha M. A. Saleh ◽

Peter N[oslash]rregaard ◽

Henrik L. J[oslash]rgensen ◽

Per K. Andersen ◽

Peter Matzen

Keyword(s):

Stent Placement ◽

Meta Analysis ◽

Morbidity And Mortality ◽

Endoscopic Stent

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Preoperative endoscopic stent placement before pancreaticoduodenectomy: A meta-analysis of the effect on morbidity and mortality

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(02)70438-0 ◽

2002 ◽

Vol 56 (4) ◽

pp. 529-534 ◽

Cited By ~ 74

Author(s):

Martha M.A. Saleh ◽

Peter Nørregaard ◽

Henrik L. Jørgensen ◽

Per K. Andersen ◽

Peter Matzen

Keyword(s):

Stent Placement ◽

Meta Analysis ◽

Morbidity And Mortality ◽

Endoscopic Stent

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Endoscopic Stent Insertion versus Primary Operative Management for Spontaneous Rupture of the Esophagus (Boerhaave Syndrome): An International Study Comparing the Outcome

The American Surgeon ◽

10.1177/000313481307900627 ◽

2013 ◽

Vol 79 (6) ◽

pp. 634-640 ◽

Cited By ~ 34

Author(s):

Michael Schweigert ◽

Rory Beattie ◽

Norbert Solymosi ◽

Karen Booth ◽

Attila Dubecz ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Stay ◽

Spontaneous Rupture ◽

Fatal Outcome ◽

Stent Insertion ◽

Endoscopic Stenting ◽

Stent Group ◽

Endoscopic Stent ◽

Boerhaave Syndrome

Spontaneous rupture of the esophagus (Boerhaave syndrome) is an extremely rare, life-threatening condition. Traditionally surgery was the treatment of choice. Endoscopic stent insertion offers a promising alternative. The aim of this study was to compare the results of primary surgical therapy with endoscopic stenting. A British and a German high-volume center for esophageal surgery participated in this retrospective study. At the British center, operative therapy (primary repair or surgical drainage) was routinely carried out. Endoscopic stent insertion was the primary treatment option at the German center. Only patients with nonmalignant, spontaneous rupture of the esophagus (Boerhaave syndrome) were included. Demographic characteristics, comorbidity, clinical course, and outcome were analyzed. The study comprises 38 patients with a median age of 60 years. Time between rupture and treatment was less than 24 hours in 22 patients. Overall mortality was four of 38. Diagnosis greater than 24 hours was associated with higher risk for fatal outcome (odds ratio [OR], 4.64; 95% confidence interval [CI], 0.33 to 265.79). The surgery (S) and the endoscopic stent group (E) included 20 and 13 cases, respectively. Esophagectomy was unavoidable in three cases and two were managed conservatively. There were no significant differences in age, time to diagnosis less than 24 hours, intensive care unit days, hospital stay, sepsis, renal failure, slow respiratory weaning, or presence of comorbidity between the two groups. In 11 of 13 in the stent group, operative intervention (video-assisted thoracic surgery, thoracotomy, mediastinotomy) was eventually mandatory and three of 13 even required repeated surgery. The rate of reoperation in the surgery group was six of 20. Mortality was two of 13 (E) versus one of 20 (S). The odds for fatal outcome were 3.3 times higher in the stent group than in the surgery group (OR, 3.32; 95% CI, 0.15 to 213.98). Management of Boerhaave syndrome by means of endoscopic stent insertion offers no advantage regarding morbidity, intensive care unit or hospital stay, and is associated with frequent treatment failure eventually requiring surgical intervention. Furthermore, endoscopic stenting shows a higher risk for fatal outcome than primary surgical therapy.

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ID: 3524317 ENDOSCOPIC STENT PLACEMENT IN THE MANAGEMENT OF STRICTURES IN CROHN’S DISEASE: A META-ANALYSIS OF OBSERVATIONAL STUDIES

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2021.03.104 ◽

2021 ◽

Vol 93 (6) ◽

pp. AB19-AB20

Author(s):

Yaniuska Lescaille ◽

Le-Chu Su ◽

Garrett Lawlor ◽

Ravi P. Kiran ◽

Bo Shen

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Stent Placement ◽

Observational Studies ◽

Meta Analysis ◽

Endoscopic Stent

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Clinical Feasibility and Safety of Endoscopic Self-Expandable Metal Stent Placement for Upper Gastrointestinal Pathologies

International Surgery ◽

10.9738/intsurg-d-15-00169.1 ◽

2019 ◽

Vol 103 (11-12) ◽

pp. 605-612

Author(s):

Bünyamin Gürbulak ◽

Esin Kabul Gürbulak ◽

Hasan Bektaş ◽

İsmail Ethem Akgün ◽

Hızır Yakup Akyildiz ◽

...

Keyword(s):

Success Rate ◽

Stent Placement ◽

Clinical Success ◽

Clinical Success Rate ◽

Endoscopic Stenting ◽

Covered Stents ◽

Success Rates ◽

Endoscopic Stent ◽

Technical Success Rate ◽

Upper Gastrointestinal

We aimed to review our experiences to evaluate the practicality, safety, and effectiveness of endoscopic stent placement for the palliation of malignant obstructions of the upper gastrointestinal system (GIS) and the treatment of postoperative complications such as failure of anastomoses and fistulae. Endoscopic stent placement is increasingly used in the upper GIS for the management of both high grade malignancies causing obstruction and benign pathologies such as anastomosis failures, gastrointestinal fistulae, and strictures. Hospital records, clinical data, and endoscopy reports of 61 patients who had undergone endoscopic stenting between the years 2012 and 2015 were analyzed retrospectively. For all patients, self-expandable metal covered stents were used. Data involving technical and clinical success rates, complication, morbidity, and mortality rates of the endoscopic stenting procedure was collected and simple statistical analyses were made. Endoscopic stenting was successful in 60 of 61 patients (98.3%). Overall technical success rate was found to be 98.3%; clinical success rate, 86.6%; complication rate, 4.9%. No stent related mortality was observed in our series. Endoscopic stents can be effectively and safely used in the treatment of various lesions of the upper GIS.

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Antroduodenal Stenting for Malignant Gastric Outlet Obstruction: Technique and Outcome

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_64_18 ◽

2019 ◽

Vol 10 (01) ◽

pp. 021-027

Author(s):

Uday C. Ghoshal ◽

Vinay Kumar

Keyword(s):

Gastric Outlet Obstruction ◽

Stent Placement ◽

Clinical Success ◽

Outlet Obstruction ◽

Stent Migration ◽

Severe Malnutrition ◽

Success Rates ◽

Stent Occlusion ◽

Endoscopic Stent ◽

Presenting Symptoms

ABSTRACTGastric outlet obstruction (GOO) is usually a late presentation of gastric cancer, pancreaticobiliary malignancy, and extrinsic lymph nodal compression. Presenting symptoms are abdominal pain, postprandial epigastric fullness, and recurrent vomiting, which lead to severe malnutrition and dehydration and poor quality of life (QoL). Endoscopic enteral stent placement has become the acceptable alternative modality for palliation of malignant GOO because it is safe, minimally invasive, and a cost-effective procedure. In addition, endoscopic stent placement leads to shorter time to resume oral diet and shorter hospital stay in comparison to surgical bypass. Endoscopic stent placement is associated with high technical as well as clinical success rates and improvement in QoL, but no survival improvement. Recurrence of symptoms occurs due to stent occlusion, or stent migration, which can be successfully managed with repeat endoscopic stent placement. Perforation and bleeding are serious but rare complications.

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Sa1406 UNILATERAL VERSUS BILATERAL ENDOSCOPIC STENTING IN PATIENTS WITH UNRESECTABLE MALIGNANT HILAR OBSTRUCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2019.03.200 ◽

2019 ◽

Vol 89 (6) ◽

pp. AB217-AB218

Author(s):

Mohamad Aghaie Meybodi ◽

Delaram Shakoor ◽

Julie Nanavati ◽

Yervant Ichkhanian ◽

Kia Vosoughi ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Endoscopic Stenting ◽

Malignant Hilar Obstruction

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Predictors of stent dysfunction in patients with bilateral metal stents for malignant hilar obstruction

PLoS ONE ◽

10.1371/journal.pone.0249096 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0249096

Author(s):

Hoonsub So ◽

Chi Hyuk Oh ◽

Tae Jun Song ◽

Sung Woo Ko ◽

Jun Seong Hwang ◽

...

Keyword(s):

Overall Survival ◽

Stent Placement ◽

Clinical Success ◽

Cumulative Risk ◽

Large Cell ◽

Stent Insertion ◽

Cell Type ◽

Metal Stent ◽

Stent Patency ◽

Malignant Hilar Obstruction

Introduction For unresectable hilar obstruction, restoring and maintaining biliary ductal patency are crucial for improved survival and quality of life. The endoscopic placement of stents is now a mainstay of its treatment, and bilateral stenting is effective for biliary decompression. This study aimed to determine the clinical outcomes of bilateral metal stent placement using large cell-type stents and the clinical predictors of stent dysfunction in patients with malignant hilar obstruction. Methods We performed a retrospective analysis of patients who underwent bilateral metal stent placement using two large cell-type stents at two academic teaching hospitals between September 2017 and February 2019. The primary outcome was stent dysfunction. Secondary outcomes included predictors related to stent dysfunction and overall survival. Results The study included 87 patients who underwent bilateral metal stent placement for malignant hilar obstruction. Technical success and clinical success were achieved in 80 patients (92.0%) and 83 patients (95.4%), respectively. During the follow-up period (median: 201, range: 18–671 days), stent dysfunction occurred in 42 patients (48.3%), and the median stent patency was 199 days (95% confidence interval [CI]: 181–262). In univariate analysis, age, cholangitis before stent insertion, and subsequent chemotherapy were found to be associated with the cumulative risk of stent dysfunction. In multivariate analysis, cholangitis before stent insertion (hazards ratio [HR]: 2.26, 95% CI: 1.216–4.209, P = 0.010) and subsequent chemotherapy (HR: 0.250, 95% CI: 0.130–0.482, P<0.001) remained as statically significant factors associated with the cumulative risk of stent dysfunction. The median overall survival was 288 days (95% CI: 230–327). Conclusion The bilateral placement of large cell-type stents for malignant hilar obstruction was effective with high technical and clinical success rates and acceptable patency. Cholangitis before stent insertion was associated with shorter patency, and subsequent chemotherapy was associated with longer stent patency.

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