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Review
. 2023 Jan 30:13:1105728.
doi: 10.3389/fonc.2023.1105728. eCollection 2023.

Is percutaneous drainage better than endoscopic drainage in the management of patients with malignant obstructive jaundice? A meta-analysis of RCTs

Cnogwen Bian  1   2 , Yuan Fang  1 , Jun Xia  3 , Lan Shi  4 , Hanfei Huang  1 , Qiru Xiong  5 , Ruolin Wu  6 , Zhong Zeng  1
Affiliations
Review

Is percutaneous drainage better than endoscopic drainage in the management of patients with malignant obstructive jaundice? A meta-analysis of RCTs

Cnogwen Bian et al. Front Oncol. .

Abstract

To compare the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangial drainage (PTCD) in the treatment of malignant obstructive jaundice, a systematic review and meta-analysis of published studies was undertaken to assess the differences between the two procedures in terms of efficacy and safety. From November 2000 to November 2022, the Embase, PubMed, MEDLINE, and Cochrane databases were searched for randomized controlled trials (RCTs) on the treatment of malignant obstructive jaundice with ERCP or PTCD. Two investigators independently assessed the quality of the included studies and extracted the data. Six RCTs, including 407 patients, were included. The results of the meta-analysis showed that the overall technical success rate in the ERCP group was significantly lower than that in the PTCD group (Z=3.19, P=0.001, OR=0.31 (95% CI: 0.15-0.64)), but with a higher overall procedure-related complication incidence rate (Z=2.57, P=0.01, OR=0.55 (95% CI: 0.34-0.87)). The incidence of procedure-related pancreatitis in the ERCP group was higher than that in the PTCD group (Z=2.80, P=0.005, OR=5.29 (95% CI: 1.65-16.97)), and the differences were statistically significant. No significant difference was observed between the two groups when the clinical efficacy, postoperative cholangitis, and bleeding rate were compared.Both treatments for malignant obstructive jaundice were efficacious and safe. However, the PTCD group had a greater technique success rate and a lower incidence of postoperative pancreatitis.The present meta-analysis has been registered in PROSPERO.

Keywords: ERCP; Malignant obstructive jaundice; Meta-analysis; PTCD; Procedure-related complication.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart summarizing the study selection process. The enrolled studies represent a total of 6 RCTs and encompass 207 patients with ERCP and 200 patients with PTCD. After quality assessment, all studies were interpreted as high-quality studies. The characteristics of the studies are depicted in Table 1 .
Figure 2
Figure 2
Quality assessment of the enrolled studies.
Figure 3
Figure 3
Forest plot comparing the technical success.
Figure 4
Figure 4
Forest plot comparing the clinical effectiveness.
Figure 5
Figure 5
Forest plot comparing the overall complication rate.
Figure 6
Figure 6
Forest plot comparing the incidence of procedure-related cholangitis.
Figure 7
Figure 7
Forest plot comparing the incidence of procedure-related pancreatitis.
Figure 8
Figure 8
Forest plot comparing the incidence of procedure-related hemorrhage.
Figure 9
Figure 9
Funnel plot evaluating publication bias for technical success.
See this image and copyright information in PMC

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