STENT VERSUS BALLOON DILATION FOR THE TREATMENT OF DOMINANT STRICTURES IN PRIMARY SCLEROSING CHOLANGITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Aims Primary sclerosing cholangitis (PSC) is a chronic fibro-inflammatory disease of the biliary system, which causes cholestatic symptoms, hepatic failure, and increases the risk of cholangiocarcinoma. Many patients with PSC presents with a dominant stricture, which can intensify the cholestatic symptoms, and endoscopic therapies are often used to maintain the patency of the biliary tract. However, the best therapeutic approach to treat dominant strictures remains unclear. This study aims to compare balloon dilation with stent placement for the treatment of dominant stricture in patients with PSC.

Methods Electronic searches were performed using MEDLINE, EMBASE, Cochrane CENTRAL, and Lilacs/Bireme databases with no restrictions on the date or language. Studies comparing balloon dilation and stent placement for treatment of dominant stricture in PSC were included. The outcomes of interest were clinical efficacy, recurrence, cumulative recurrence-free rate, transplant rate, 5-year survival rate, adverse events, and mortality.

Results The initial search identified 1,118 citations. Five studies with a total of 467 patients (190 in the dilation group and 277 in the stent group) were included in the final analysis. Only one was an RCT, and the rest were retrospective cohort studies. Adverse events were higher in the stent group (RD -0.34 (95%CI -0.45, -0.23), p-value < 0.00001). Among the adverse events, the incidence of cholangitis was significantly higher in the stent group (RD -0.19 (95%CI -0.25, -0.13), p-value < 0.00001). However, other outcomes including clinical efficacy, transplant rate, pancreatitis, perforation, and cholangiocarcinoma were similar in both groups. Recurrence, cumulative recurrence-free rate, 5-year survival rate, mortality, bleeding, pain, and ascites could not be included in the quantitative analyses due to missing data.

Conclusions The efficacy of balloon dilation and stents in the treatment of dominant stricture in patients with PSC appears to be similar. However, stents are associated with a significantly higher occurrence of adverse events, particularly cholangitis.