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INTRODUCTION AND AIM: Unresectable malignant distal biliary obstruction is a condition that should be treated with drainage and clearance of the biliary duct. self-expanded metal stents (SEMS) are known to be better and more effective than plastic stents because the patency is longer. The actual evidence is insufficient to recommend if it is better the use of SEMSu over SEMSc or vice versa for the drainage of the malignant distal biliary obstruction during ERCP. We performed a systematic review and meta-analyses to demonstrate if exists superiority between one or other type of SEMS performed by ERCP. MATERIALS AND METHODS: We conducted a systematic review in different databases, such as PubMed, Cochrane, Medline, and OVID database. A search was made of all studies published up to May 2023. RESULTS: Seven studies were analyzed. A total of 1070 patients were included. Of the total of patients, 48.9% were male. The cumulative stent patency, the failure rate, the survival probably and the adverse events rate, were similar between SEMSc and SEMSu groups. The stent migration rate was higher in the SEMSc group (RR=2.34 [95% CI: 1.35-4.08]). The tumor overgrowth was higher in the SEMSc group (RR=2.05 [95% CI: 1.13-3.72]). The tumor ingrowth was higher in the SEMSu group (RR=0.25 [95% CI: 0.11-0.61]). CONCLUSIONS: The conclusions of our study show that there are no differences between the use of uncovered SEMS and covered SEMS for palliative treatment of distal biliopancreatic obstructions, and it has no impact on mortality or patient survival. New functional studies regarding the type of stent cover, radial force or length thereof are required.
RESUMO
Objetivo: Determinar si el resangrado de la enfermedad ulcerosa péptica (EUP) en pacientes con enfermedad renal crónica (ERC) es mayor que en los pacientes con EUP sin ERC en los pacientes hospitalizados en la Unidad de Hemorragia Digestiva del Hospital Nacional Edgardo Rebagliati Martins. Materiales y métodos: Se realizó un estudio de casos y controles, observacional, analítico y retrosprospectivo en pacientes mayores de 18 años, con resangrado por úlcera péptica, ingresados a la Unidad de Hemorragia Digestiva del Hospital Nacional Edgardo Rebagliati Martins durante un periodo de 1 año. Resultados: Total de 146 pacientes, 26 % son mujeres y 74 % varones. Media de edad: 65,47 ± 17,95 años. Los casos (EUP con ERC) fueron 34 y los controles (EUP sin ERC) fueron 112. La causa del sangrado fue úlcera duodenal en 53 % y úlcera gástrica en 47 %. La razón entre la presencia de resangrado en pacientes con EUP con ERC es 6,43 veces mayor que en pacientes con EUP sin ERC. Resangrado en pacientes con ERC 41,1 % y en los pacientes sin ERC de 9,8 %. El tipo de úlcera con mayor resangrado fue el tipo IIa en ambos grupos. El 94 % de pacientes fueron dados de alta, 2,7 % referidos a cirugía. La tasa de mortalidad total fue de 2,7 %, y de 5,8 % en los pacientes con ERC. (p=0,2). Conclusiones: La razón de resangrado de la úlcera péptica en pacientes que padecen de enfermedad renal crónica es 6,43 veces mayor que en los pacientes sin enfermedad renal crónica, La tasa de resangrado de la enfermedad ulcerosa péptica en pacientes con enfermedad renal crónica, fue del 41,1 %, mientras que en los pacientes sin enfermedad renal crónica fue de 9,8 %
Objective: To determine if rebleeding in peptic ulcer disease (PUD) in patients with chronic kidney disease (CKD) is greater than in patients without CKD hospitalized in the Digestive Bleeding Unit of the Hospital Nacional Edgardo Rebagliati Martins. Materials and methods: An observational, analytical, retro-prospective, case-control study was performed in patients >18 years with rebleeding in PUD, admitted to the Digestive Hemorrhage Unit of the Hospital Nacional Edgardo Rebagliati Martins during 1 year. Results: Out of 146 patients, 26 % were female and 74 % were male. The mean age was 65.47 ± 17.95 years. The cases (PUD with CKD) consisted of 34 patients and the controls (PUD without CKD) consisted of 112 patients. The causes of rebleeding were duodenal ulcer (53 %) and gastric ulcer (47 %). The odds ratio (OR) of rebleeding in patients with CKD was 6.43 times higher than in patients without CKD. Rebleeding in patients with CKD was 41.1 % and in patients without CKD it was 9.8 %. The type of ulcer with the greatest rebleeding was type IIa in both groups. Ninety-four percent (94 %) of the patients were discharged, and 2.7 % were referred to surgery. The total mortality rate was 2.7 %, and the mortality rate in patients with CKD was 5.8 % (p = 0.2). Conclusions: The OR of peptic ulcer rebleeding in patients with CKD is 6.43 times higher than in patients without CKD. Rebleeding in peptic ulcer disease in patients with CKD was 41.1 %, whereas in patients without CKD it was 9.8 %.
