Clinical effect of endoscopic nasobiliary drainage versus endoscopic biliary stenting in preoperative biliary drainage for low-level malignant obstructive jaundice: A Meta-analysis / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the clinical effect and safety of endoscopic nasobiliary drainage (ENBD) versus endoscopic biliary stenting (EBS) in preoperative biliary drainage for low-level malignant obstructive jaundice. MethodsChinese and English databases were searched for control studies on the clinical effect of ENBD versus EBS in preoperative biliary drainage for low-level malignant obstructive jaundice published up to August 2020. After quality assessment and data extraction were performed for the studies included, RevMan 53 software was used to perform the meta-analysis. ENBD and EBS were compared in terms of incidence rates of preoperative cholangitis and preoperative pancreatitis, stent dysfunction rate, overall incidence rate of complications before and after surgery, and rate of postoperative pancreatic leakage. ResultsSix studies involving 1182 patients were included. The meta-analysis showed that there were no significant differences between the ENBD group and the EBS group in incidence rate of preoperative pancreatitis (odds ratio ［OR］=0.66, 95% confidence interval ［CI］ 0.44-0.99, P=0.05), stent dysfunction rate (OR=1.14, 95% CI 0.56-2.31, P=0.72), and overall incidence rate of complications before and after surgery (OR=0.69, 95% CI 0.41-1.15, P=0.15). Compared with the EBS group, the ENBD group had significant reductions in incidence rate of preoperative cholangitis (OR=0.34, 95% CI 0.23-0.50, P＜0.000 01) and rate of postoperative pancreatic leakage (OR=0.53, 95% CI 0.32-0.88, P=0.01). ConclusionPreoperative biliary drainage with ENBD is superior to EBS in patients with well-diagnosed low-level malignant obstructive jaundice. More large multicenter randomized controlled trials are needed in the future to verify this conclusion.