Preoperative biliary drainage for perihilar cholangiocarcinoma: A Meta-analysis / 中华肝胆外科杂志

Objective To systematically review the effectiveness and safety of percutaneous transhepatic biliary drainage (PTBD) versus endoscopic biliary drainage (EBD) for preoperative biliary drainage in patients with Klatskin Tumors.Methods The Pubmed,Embase,Web of Science,CNKI,VIP and WanFang Data from January 1998 to December 2017 were searched for published studies which compared endoscopic biliary drainage (EBD) with percutaneous transhepatic biliary drainage (PTBD) for preoperative biliary drainage.A Meta-analysis was then performed using the Revman 5.3 software.Results Seven cohort studies were included.There were 366 patients in the PTBD group,and 400 patients in the EBD groups.When compared with EBD,PTBD was associated with a lower risk of cholangitis (OR=0.31,95％ CI 0.20～0.48,P＜0.05),a lower risk of pancreatitis (OR=0.11,95％ CI 0.04 ～ 0.34,P＜0.05),and a lower risk of overall complications (OR=0.48,95％ CI 0.30 ～ 0.77,P=0.002).The rate of conversion from one procedure to the other was significantly lower in the PTBD group than the EBD group.The initial technical success rate and postoperative morbidity and mortality rates were similar in the 2 groups.Conclusion In patients with Klatskin tumors who require PBD,PTBD is a better initial biliary drainage method with lower incidences of procedure-related cholangitis,pancreatitis overall complications and conversion to other drainage procedures.

Metallic EndoCoilTM Stent Application for Patients with Malignant Obstructive Jaundice / 대한소화기내시경학회지

We report our experience in five patients with malignant obstructive jaundice with a new self expandable metallic stent, a coil spring made from nickel-titanium alloy. Endoscopic biliary drainage(EBD) is a safe and effective noninvasive biliary drainage method and is indicated with malignant obstructive jaundice. In order to avoid being limited by the size of the instrumentation channel of the endoscope, expandable stents have been developed. The main problems with these expandable metal stents are tumor ingrowth leading to reobstruction, migration of the stent from its original position, and epithelial trauma by the distal hard edges of the stent. The new super-elastic metallic coil stent which has a very strong radial force (EndoCoil'" stent, Instent Co.) was developed to solve the above mentioned problems. The stent which is constricted over an introducing catheter is inserted by transduodenal approach. It expands spontaneously after release to its original 8 mm diameter. During the last 6.5 rnonths, 5 stents were inserted in patients with cholangiocarcinoma, pancreatic carcinoma and cancer of the ampulla of Vater to releave jaundice. Clinical improvement was achieved in all the patients except in one who died from multiple organ metastasis. After a mean follow-up of 6 month., patients had no evidence of biliary reobstruction. Although follow-up is short, these results are encouraging, and this new metallic stent seems to have several advantages over the current commercially available ones.