title: Comparison of percutaneous transhepatic biliary drainage and endoscopic biliary drainage in the management of malignant biliary tract obstruction: a meta-analysis.
abstract: OBJECTIVE
  To compare percutaneous transhepatic biliary drainage (PTBD) and endoscopic biliary drainage (EBD) for management of malignant biliary tract obstruction (MBTO).
  
  
  METHODS
  PubMed, Google Scholar, and the Cochrane database were searched to 31 December 2013. Main outcome measurements were therapeutic success rate, 30-day mortality rate, overall complications, cholangitis, and pancreatitis.
  
  
  RESULTS
  Eight studies (five retrospective and three randomized controlled trials) were included in the meta-analysis with a total of 692 participants. Combined odds ratio (OR) = 2.18 revealed no significant difference in therapeutic success between PTBD and EBD (95% confidence interval [CI] = 0.73-6.47, P = 0.162). However, after excluding two studies that appeared to be outliers, PTBD exhibited a better therapeutic success rate than EBD (pooled OR = 4.45, 95% CI = 2.68-7.40, P < 0.001). Patients who underwent PTBD were 0.55 times as likely to have cholangitis as those who underwent EBD, whereas the overall complication rate, pancreatitis rate, and 30-day mortality were similar between the two procedures.
  
  
  CONCLUSIONS
  PTBD may be associated with a better therapeutic success rate and lower incidence of cholangitis than EBD, but the overall complication rate, pancreatitis rate, and 30-day mortality of the two procedures are similar.
authors.affiliation: Department of Hepatobiliary Surgery, Hainan Branch of Chinese PLA General Hospital, Sanya, China.
authors.forename: Xiang-qian
authors.initials: XQ
authors.lastname: Zhao
authors.forename: Jia-hong
authors.initials: JH
authors.lastname: Dong
authors.forename: Kai
authors.initials: K
authors.lastname: Jiang
authors.forename: Xiao-qiang
authors.initials: XQ
authors.lastname: Huang
authors.forename: Wen-zhi
authors.initials: WZ
authors.lastname: Zhang
mesh_terms: D001661:Biliary Tract Neoplasms / Q000150:complications* / Q000601:surgery; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D006801:Humans
keywords: endoscopic biliary drainage; malignant biliary tract obstruction; meta-analysis; percutaneous transhepatic biliary drainage