title: Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review.
abstract: BACKGROUND
  In patients requiring surgical resection for malignant biliary jaundice, it is unclear if preoperative biliary drainage (PBD) would improve mortality and morbidity by restoration of biliary flow prior to operation. This is a meta-analysis to pool the evidence and assess the utility of PBD in patients with malignant obstructive jaundice. The primary outcome is comparing mortality outcomes in patients with malignant obstructive jaundice undergoing direct surgery (DS) versus PBD. The secondary outcomes include major adverse events and length of hospital stay in both the groups.
  
  
  METHODS
  Studies using PBD in patients with malignant obstructive jaundice were included in this study. For the data collection and extraction, articles were searched in MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, etc. Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian-Laird method (random effects model).
  
  
  RESULTS
  Initial search identified 2230 reference articles, of which 204 were selected and reviewed. Twenty-six studies (N = 3532) for PBD in malignant obstructive jaundice which met the inclusion criteria were included in this analysis. The odds ratio for mortality in PBD group versus DS group was 0.96 (95 % CI = 0.71 to 1.29). Pooled number of major adverse effects was lower in the PBD group at 10.40 (95 % CI = 9.96 to 10.83) compared to 15.56 (95 % CI = 15.06 to 16.05) in the DS group. Subgroup analysis comparing internal PBD to DS group showed lower odds for major adverse events (odds ratio, 0.48 with 95 % CI = 0.32 to 0.74).
  
  
  CONCLUSIONS
  In patients with malignant biliary jaundice requiring surgery, PBD group had significantly less major adverse effects than DS group. Length of hospital stay and mortality rate were comparable in both the groups.
authors.affiliation: Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA. harsha1778@yahoo.co.in.|Department of Medicine, University of Illinois College of Medicine Peoria, 530 NE Glen Oak Ave, Peoria, IL, 61637, USA. harsha1778@yahoo.co.in.
authors.forename: Harsha
authors.initials: H
authors.lastname: Moole
authors.affiliation: Department of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bechtold
authors.affiliation: Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Puli
mesh_terms: D001661:Biliary Tract Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D004379:Duodenal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000601:surgery*; D007902:Length of Stay; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic
keywords: Cholangiocarcinoma; Malignant biliary stricture; Malignant obstructive jaundice; Meta-analysis; Pancreatic head cancer; Pancreaticoduodenectomy; Peri-ampullary malignancy; Preoperative biliary drainage; Systematic review