Author/Authors :
Moole, Harsha Division of General Internal Medicine - University of Illinois College of Medicine at Peoria, USA , Dharmapuri, Sirish Department of Internal Medicine - Wilkes-Barre Veterans Affairs Medical Center, Scranton, USA , Duvvuri, Abhiram Department of Gastroenterology and Hepatology - Kansas City Veteran Affairs Medical Center, Kansas City, USA , Dharmapuri, Sowmya Division of General Internal Medicine - NTR University of Health Sciences, Andhra Pradesh, India , Boddireddy, Raghuveer Division of General Internal Medicine - NTR University of Health Sciences, Andhra Pradesh, India , Moole, Vishnu Division of General Internal Medicine - NTR University of Health Sciences, Andhra Pradesh, India , Yedama, Prathyusha Division of General Internal Medicine - NTR University of Health Sciences, Andhra Pradesh, India , Bondalapati, Naveen Division of Medicine - Barnes Jewish Christian Medical Group - Christian Hospital, USA , Uppu, Achuta Department of Medicine - Bronx Lebanon Hospital Center, USA , Yerasi, Charan Department of Medicine - MedStar Georgetown University Hospital and MedStar Washington Hospital Center, Washington, DC, USA
Abstract :
Background. Palliation in advanced unresectable hilar malignancies can be achieved by endoscopic (EBD) or percutaneous transhepatic biliary drainage (PTBD). It is unclear if one approach is superior to the other in this group of patients. Aims. Compare clinical outcomes of EBD versus PTBD. Methods. (i) Study Selection Criterion. Studies using PTBD and EBD for palliation of advanced unresectable hilar malignancies. (ii) Data Collection and Extraction. Articles were searched in Medline, PubMed, and Ovid journals. (iii) Statistical Method. Fixed and random effects models were used to calculate the pooled proportions. Results. Initial search identified 786 reference articles, in which 62 articles were selected and reviewed. Data was extracted from nine studies (N = 546) that met the inclusion criterion. The pooled odds ratio for successful biliary drainage in PTBD versus EBD was 2.53 (95% CI = 1.57 to 4.08). Odds ratio for overall adverse effects in PTBD versus EBD groups was 0.81 (95% CI = 0.52 to 1.26). Odds ratio for 30-day mortality rate in PTBD group versus EBD group was 0.84 (95% CI = 0.37 to 1.91). Conclusions. In patients with advanced unresectable hilar malignancies, palliation with PTBD seems to be superior to EBD. PTBD is comparable to EBD in regard to overall adverse effects and 30-day mortality.
Keywords :
Endoscopic versus , Percutaneous Biliary Drainage , Palliation , Hilar Obstruction
