title: Endoscopic versus Percutaneous Biliary Drainage in Palliation of Advanced Malignant Hilar Obstruction: A Meta-Analysis and Systematic Review.
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.
authors.affiliation: Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
authors.forename: Harsha
authors.identifier: 0000-0002-7516-5980
authors.initials: H
authors.lastname: Moole
authors.affiliation: Department of Internal Medicine, Wilkes-Barre Veterans Affairs Medical Center, Scranton, PA, USA.
authors.forename: Sirish
authors.initials: S
authors.lastname: Dharmapuri
authors.affiliation: Department of Gastroenterology and Hepatology, Kansas City Veteran Affairs Medical Center, Kansas City, MO, USA.
authors.forename: Abhiram
authors.initials: A
authors.lastname: Duvvuri
authors.affiliation: Division of General Internal Medicine, NTR University of Health Sciences, Andhra Pradesh, India.
authors.forename: Sowmya
authors.initials: S
authors.lastname: Dharmapuri
authors.affiliation: Division of General Internal Medicine, NTR University of Health Sciences, Andhra Pradesh, India.
authors.forename: Raghuveer
authors.initials: R
authors.lastname: Boddireddy
authors.affiliation: Division of General Internal Medicine, NTR University of Health Sciences, Andhra Pradesh, India.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Moole
authors.affiliation: Division of General Internal Medicine, NTR University of Health Sciences, Andhra Pradesh, India.
authors.forename: Prathyusha
authors.initials: P
authors.lastname: Yedama
authors.affiliation: Division of Medicine, Barnes Jewish Christian Medical Group, Christian Hospital, St. Louis, MO, USA.
authors.forename: Naveen
authors.initials: N
authors.lastname: Bondalapati
authors.affiliation: Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY, USA; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Achuta
authors.initials: A
authors.lastname: Uppu
authors.affiliation: Department of Medicine, MedStar Georgetown University Hospital and MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Charan
authors.identifier: 0000-0002-3916-3216
authors.initials: C
authors.lastname: Yerasi
mesh_terms: D000328:Adult; D001650:Bile Duct Neoplasms / Q000150:complications / Q000473:pathology; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D018285:Klatskin Tumor / Q000150:complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010166:Palliative Care / Q000379:methods*