Meta-analysis Of The Treatment Of Malignant Extrahepatic Biliary Obstruction By Placing CSEMS And USEMS Through ERCP And PTC

Objective:To systematically evaluate the efficacy and postoperative safety of ERCP and PTC implantation CSEMS and USEMS in the treatment of malignant extrahepatic biliary obstruction Methods:CNKI,CQVIP,Wanfangdata,EMBASE,Cochrane Library,Pub Med were searched to find randomized controlled trials on the treatment of malignant extrahepatic biliary obstruction with CSEMS and USEMS implanted by ERCP and PTC.The quality of the included literature was evaluated,and then Rev Man 5.3 software was used for data analysis.Results:A total of 14 randomized controlled trials were included,with a total of 1485 patients with malignant extrahepatic biliary obstruction(including 743 cases in the covered group and 742 cases in the uncovered group).The results of Meta analysis showed that 1-year survival rate,1-year stent patency rate and postoperative complications,there was no significant difference in the results between the covered group and the uncovered group(both P>0.05);in the postoperative stent dysfunction,stent migration(RR=7.56,95%CI 2.66～21.45,P=0.0001),tumor ingrowth(RR=0.25,95%CI 0.12～0.51,P=0.0002),tumor overgrowth(RR=2.19,95%CI 1.30～3.68,P=0.003),sludge formation(RR=2.78,95%CI 0.73～5.91,P=0.0002),the difference between the covered group and the uncovered group was statistically significant.The covered group is more prone to stent migration,tumor overgrowth,and stent migration,while the uncovered group is more prone to tumor ingrowth.In the subgroup analysis,the difference between the ERCP subgroup and the PTC subgroup is mainly manifested in postoperative stent dysfunction and postoperative complications.Conclusion:In terms of 1-year survival rate and 1-year stent patency rate,there was no significant difference in results between the covered group and the uncovered group.In terms of stent dysfunction,the covered group is more prone to stent migration,tumor overgrowth,and sludge formation than the uncovered group.The uncovered group is more prone to tumor stent ingrowth.The difference in stent dysfunction may be caused by the characteristics of the stent itself,and has little to do with the way the stent is placed.In terms of postoperative complications,although there is no significant difference between the covered group and the uncovered group,the use of ERCP to place metal stents is better than that of PTC.The placement method is more likely to induce inflammation of the biliary system,especially pancreatitis.