Stent insertion for malignant hilar obstruction: a meta-analysis of percutaneous versus endoscopic approaches

Introduction
In an effort to treat patients with malignant hilar obstruction (MHO), both percutaneous trans-hepatic biliary stenting (PTBS) and endoscopic biliary stenting (EBS) strategies have been implemented in the clinic, but the relative advantages of these techniques remain to be clarified.

Aim
This meta-analysis was designed to compare the relative clinical efficacy of PTBS and EBS in MHO patients.

Material and methods
Relevant studies were identified through searches of the PubMed, Web of science, and Wanfang databases, and pooled analyses of these studies were then performed.

Results
 In total, this meta-analysis included 11 studies enrolling 530 and 645 patients who underwent PTBS and EBS, respectively. Pooled rates of technical success in the PTBS patients were significantly higher than those for EBS patients (p < 0.0001). PTBS patients also exhibited significantly lower pooled cholangitis (p = 0.03) and pancreatitis (p < 0.0001) rates as compared to individuals in the EBS group. However, there were no significant differences in pooled clinical success rates (p = 0.45), haemorrhage rates (p = 0.57), stent patency (p = 0.96), or overall survival (p = 0.73) when comparing these groups. In a subgroup analysis, PTBS was not found to be superior to EBS as a treatment for Bismuth type III/IV MHO patients. However, PTBS did exhibit superior technical success and complication rates relative to EBS when treating hilar cholangiocarcinoma patients.

Conclusions
PTBS is superior to EBS with respect to many technical success and safety criteria when employed for the management of MHO patients.