Endoscopy 2019; 51(04): S38
DOI: 10.1055/s-0039-1681282
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: ERCP stenosis Club H
Georg Thieme Verlag KG Stuttgart · New York

DOUBLE STENTING SEEMS TO BE BETTER THAN DOUBLE BYPASS IN CASE OF COMBINED MALIGNANT BILIARY AND DUODENAL OBSTRUCTION: META-ANALYSIS AND SYSTEMATIC REVIEW

A Fábián
1   First Department of Internal Medicine, University of Szeged, Szeged, Hungary
,
R Bor
1   First Department of Internal Medicine, University of Szeged, Szeged, Hungary
,
N Gede
2   Institute for Translational Medicine, University of Pécs, Pécs, Hungary
,
P Bacsur
1   First Department of Internal Medicine, University of Szeged, Szeged, Hungary
,
D Pécsi
2   Institute for Translational Medicine, University of Pécs, Pécs, Hungary
,
P Hegyi
2   Institute for Translational Medicine, University of Pécs, Pécs, Hungary
,
B Tóth
3   University of Szeged, Szeged, Hungary
,
Z Szakács
2   Institute for Translational Medicine, University of Pécs, Pécs, Hungary
,
Á Vincze
4   First Department of Medicine, Division of Gastroenterology, University of Pécs, Pécs, Hungary
,
I Ruzsics
5   Department of Pulmonology, University of Pécs, Pécs, Hungary
,
Z Rakonczay
6   Department of Pathophysiology, University of Szeged, Szeged, Hungary
,
B Erőss
2   Institute for Translational Medicine, University of Pécs, Pécs, Hungary
,
R Sepp
7   Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
,
Z Szepes
1   First Department of Internal Medicine, University of Szeged, Szeged, Hungary
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

To assess feasibility and optimal method of double stenting of malignant duodenal and biliary obstruction compared to surgical double bypass.

Methods:

A systematic literature search was performed to assess feasibility and optimal method of double stenting of malignant duodenal and biliary obstruction compared to surgical double bypass in terms of technical and clinical success, adverse events, reinterventions, and survival. A total of 72 retrospective and 8 prospective studies published until July 2018 were enrolled.

Results:

Technical and clinical success of double stenting was 97% (95% CI: 95 – 99%) and 92% (95% CI: 89 – 95%), respectively. Technical success showed no difference, but clinical success of endoscopic biliary stenting was higher than that of surgery (97% [95% CI: 94 – 99%] vs. 86% [95% CI: 78 – 92%], p < 0.001). Double stenting was associated with less adverse events (14% [95% CI: 9 – 19%] vs. 24% [95% CI: 16 – 34%], p = 0.033) but with more reinterventions (22% [95% CI: 17 – 27%] vs. 9% [95% CI: 3 – 18%], p < 0.01). Mean survival was similar in the groups. No difference was found between technical and clinical success and reintervention rate of ERCP, PTD and EUS-BD. ERCP was associated with the least adverse event (4% [95% CI: 1 – 8%]), followed by PTD (10% [95% CI: 0 – 37%]) and EUS-BD (28% [95% CI: 17 – 41%]).

Conclusions:

In the difficult-to-treat cohort of patients with combined malignant biliary and duodenal obstruction, substantially high technical and clinical success rate can be reached with double stenting. ERCP should be recommended as the first choice for biliary stenting as a part of double stenting. Prospective comparative studies with well-defined outcomes and patient cohorts are needed to determine those who may benefit the most from double stenting.