eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
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SCImago Journal & Country Rank
4/2020
vol. 16
 
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Hepatology
abstract:
Systematic review/Meta-analysis

Internal drainage versus external drainage in palliation of malignant biliary obstruction: a meta-analysis and systematic review

Xiaopeng Tian
1, 2
,
Zixuan Zhang
1
,
Wen Li
1, 3

1.
Medical School of Chinese PLA, Beijing, China
2.
Department of Gastroenterology, Xingtai People’s Hospital, Xingtai, Hebei, China
3.
Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
Arch Med Sci 2020; 16 (4): 752–763
Online publish date: 2020/04/06
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Introduction
Preoperative biliary drainage has been widely used to treat patients with malignant biliary obstruction. However, it is still unclear which method is more effective: internal drainage or external drainage. Thus, we carried out a meta-analysis to compare the safety and efficacy of the two drainage methods in treatment of malignant biliary obstruction in terms of preoperative and postoperative complications.

Material and methods
We conducted a literature search of Medline, EMBASE, PubMed, Ovid journals and the Cochrane Library, and compared internal drainage and external drainage in malignant biliary obstruction patients. The pre- and postoperative complications, stent dysfunction rate and mortality were analyzed.

Results
Ten published studies (n = 1464 patients) were included in this meta-analysis. We found that patients with malignant biliary obstruction who received external drainage showed reductions in the preoperative cholangitis rate (OR = 0.33, 95% CI: 0.24–0.44, p < 0.00001), the incidence of stent dysfunction (OR = 0.41, 95% CI: 0.30–0.57, p < 0.00001), and total morbidity (OR = 0.34, 95% CI: 0.23–0.50, p < 0.00001) compared with patients who received internal drainage.

Conclusions
The current meta-analysis indicates that external drainage is better than internal drainage for malignant biliary obstruction in terms of the preoperative cholangitis rate, the incidence of stent dysfunction and total morbidity, etc. However, the findings need to be confirmed by randomized controlled trials.

keywords:

malignant biliary obstruction, preoperative biliary drainage, internal drainage, external drainage, meta-analysis

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