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Meta-Analysis
. 2016 May;18(5):400-10.
doi: 10.1016/j.hpb.2016.03.002. Epub 2016 Apr 4.

Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma - a systematic review and meta-analysis

Ahmer Hameed  1 , Tony Pang  1 , Judy Chiou  2 , Henry Pleass  1 , Vincent Lam  1 , Michael Hollands  1 , Emma Johnston  3 , Arthur Richardson  1 , Lawrence Yuen  4
Affiliations
Meta-Analysis

Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma - a systematic review and meta-analysis

Ahmer Hameed et al. HPB (Oxford). 2016 May.

Abstract

Background: The strategy for preoperative management of biliary obstruction in hilar cholangiocarcinoma (HCCA) patients with regards to drainage by endoscopic (EBD) or percutaneous (PTBD) methods is not clearly defined. The aim of this study was to investigate the utility, complications and therapeutic efficacy of these methods in HCCA patients, with a secondary aim to assess the use of portal vein embolization (PVE) in patients undergoing drainage.

Methods: Studies incorporating HCCA patients undergoing biliary drainage prior to curative resection were included (EMBASE and Medline databases). Analyses included baseline drainage data, procedure-related complications and efficacy, post-operative parameters, and meta-analyses where applicable.

Results: Fifteen studies were included, with EBD performed in 536 patients (52%). Unilateral drainage of the future liver remnant was undertaken in 94% of patients. There was a trend towards higher procedure conversion (RR 7.36, p = 0.07) and cholangitis (RR 3.36, p = 0.15) rates in the EBD group. Where specified, 134 (30%) drained patients had PVE, in association with a major hepatectomy in 131 patients (98%). Post-operative hepatic failure occurred in 22 (11%) of EBD patients compared to 56 (13%) of PTBD patients, whilst median 1-year survival in these groups was 91% and 73%, respectively.

Discussion: The accepted practice is for most jaundiced HCCA patients to have preoperative drainage of the future liver remnant. EBD may be associated with more immediate procedure-related complications, although it is certainly not inferior compared to PTBD in the long term.

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Figures

Figure 1
Figure 1
Study selection flow diagram. * Depending on number of studies in which specific parameter(s) being analysed were recorded
Figure 2
Figure 2
Forest plots generated from meta-analyses comparing EBD and PTBD with respect to: (a) post-drainage cholangitis rates; (b) conversion rates from one form of drainage procedure to the other; and (c) overall post-drainage complications. CI – confidence interval; RR – risk ratio
See this image and copyright information in PMC

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