Abstract:

Objective

To compare the safety and efficacy of ERCP with biliary stent and stent implantation across the duodenal papilla in the treatment of unresectable hilar cholangiocarcinoma.

Methods

Relevant studies of ERCP with biliary stent and stent implantation across the duodenal papilla in the treatment of unresectable hilar cholangiocarcinoma were searched from PubMed，Embase，Web of Science，Cochrane Library，China Biomedical Literature Database （CBM），CNKI，Chongqing VIP and Wanfang Data from January 2003 to June 2023. Newcastle-Ottawa Scale （NOS） was used to evaluate the quality of the included studies，and RevMan 5.4 software was used for Meta-analysis.

Results

Five studies were included in this Meta-analysis. The results showed that the patency rate of patients with stent patency time ≥3 months after biliary stent implantation was significantly higher than that of those treated with stent implantation across the duodenal papilla （OR=4.18，95%CI: 1.81-9.68， P＜0.001）. The incidence of postoperative pancreatitis was significantly lower than that of their counterparts with stent implantation across the duodenal papilla （RR=0.18，95%CI: 0.03-0.93， P=0.04）. There was no statistical significance in the incidence rates of postoperative cholangitis （RR=0.79，95%CI: 0.41-1.52， P=0.47），postoperative stent occlusion （RR=1.06，95%CI: 0.83-1.34， P=0.65），postoperative stent displacement （RR=0.52，95%CI: 0.20-1.36， P=0.18），postoperative bleeding （RR=0.96，95%CI: 0.21-4.27， P=0.95） between two groups.

Conclusions

For patients with unresectable hilar cholangiocarcinoma，ERCP with biliary stent implantation not only yields longer postoperative patency time，but also has a lower incidence of postoperative pancreatitis compared with stent implantation across the duodenal papilla，which provides a novel idea for clinical treatment.

Key words: Hilar cholangiocarcinoma, Superpapillary stent, Transpapillary stent, Metaanalysis