EUS-BD与PTBD治疗恶性梗阻性黄疸疗效的meta分析
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摘要
目的比较超声内镜引导下的胆道引流(EUS-BD)与经皮经肝穿刺胆道引流(PTBD)治疗恶性梗阻性黄疸的疗效。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM、WanFang Data和CNKI数据库,搜集EUS-BD与PTBD治疗恶性梗阻性黄疸患者疗效比较的随机对照试验(RCT)和队列研究,检索时限均从建库至2018年11月30日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后采用RevMan5.3软件进行meta分析。结果本研究共纳入3个RCT和6个队列研究,共496例患者。meta分析结果显示,EUS-BD组的术后并发症发生率[OR=0.30,95%CI(0.20,0.47),P<0.000 01]、术后再手术干预率[OR=0.11, 95%CI(0.06,0.22),P<0.000 01]、住院时间[MD=–3.42,95%CI(–6.72,–0.13),P=0.04]、住院费用[SMD=–0.83,95%CI(–1.16,–0.49),P<0.000 01]明显低(或少)于PTBD组。在技术成功率[OR=0.88,95%CI(0.20,3.85),P=0.86]和临床有效率[OR=1.73,95%CI(0.97,3.11),P=0.06]方面2组间比较差异均无统计学意义。结论现有证据表明,与PTBD相比,EUS-BD在治疗恶性梗阻性黄疸患者方面具有术后并发症发生率低、术后再手术干预率低、住院时间短、费用低等优点,而在技术成功率和临床有效率方面两者无明显差异,但由于受纳入文献数量和质量限制,上述结论尚需开展更多高质量研究予以验证。
Objective To systematically review efficacy of endoscopic ultrasonography guided biliary drainage(EUS-BD)and percutaneous transhepatic biliary drainage(PTBD)on patients with malignant obstructive jaundice.Methods The PubMed,EMbase,The Cochrane Library,CBM,WanFang Data,and CNKI were searched online to collect the randomized controlled trials or cohort studies of EUS-BD versus PTBD on the patients with malignant obstructive jaundice from inception to November 30,2018.Two reviewers independently screened the literatures,extracted the data and assessed the risk of bias of included the studies,then the meta-analysis was performed by using the RevMan 5.3software.Results Three randomized controlled trials and 6 cohort studies involving 496 patients were included.The results of meta-analysis showed that:compared with the PTBD,the EUS-BD had the lower occurrence of complications[OR=0.30,95%CI(0.20,0.47),P<0.000 01],lower rate of reintervention[OR=0.11,95%CI(0.06,0.22),P<0.000 01],shorter hospital stay[MD=–3.42,95%CI(–6.72,–0.13),P=0.04],and less hospital costs[SMD=–0.83,95%CI(–1.16,–0.49),P<0.000 01].There were no significant differences in the technical success rate[OR=0.88,95%CI(0.20,3.85),P=0.86]and clinical effective rate[OR=1.73,95%CI(0.97,3.11),P=0.06]between the two groups.Conclusions Current evidence shows that EUS-BD has some advantages of lower occurrence of complications,lower rate of reintervention,shorter hospital stay,and less hospital costs in treatment of patients with malignant obstructive jaundice as compared with PTBD.There are no significant differences between two groups in technical success rate and clinical effective rate.Due to limited quality and quantity of included studies,more high quality studies required to be verified above conclusions.
Objective To systematically review efficacy of endoscopic ultrasonography guided biliary drainage(EUS-BD)and percutaneous transhepatic biliary drainage(PTBD)on patients with malignant obstructive jaundice.Methods The PubMed,EMbase,The Cochrane Library,CBM,WanFang Data,and CNKI were searched online to collect the randomized controlled trials or cohort studies of EUS-BD versus PTBD on the patients with malignant obstructive jaundice from inception to November 30,2018.Two reviewers independently screened the literatures,extracted the data and assessed the risk of bias of included the studies,then the meta-analysis was performed by using the RevMan 5.3software.Results Three randomized controlled trials and 6 cohort studies involving 496 patients were included.The results of meta-analysis showed that:compared with the PTBD,the EUS-BD had the lower occurrence of complications[OR=0.30,95%CI(0.20,0.47),P<0.000 01],lower rate of reintervention[OR=0.11,95%CI(0.06,0.22),P<0.000 01],shorter hospital stay[MD=–3.42,95%CI(–6.72,–0.13),P=0.04],and less hospital costs[SMD=–0.83,95%CI(–1.16,–0.49),P<0.000 01].There were no significant differences in the technical success rate[OR=0.88,95%CI(0.20,3.85),P=0.86]and clinical effective rate[OR=1.73,95%CI(0.97,3.11),P=0.06]between the two groups.Conclusions Current evidence shows that EUS-BD has some advantages of lower occurrence of complications,lower rate of reintervention,shorter hospital stay,and less hospital costs in treatment of patients with malignant obstructive jaundice as compared with PTBD.There are no significant differences between two groups in technical success rate and clinical effective rate.Due to limited quality and quantity of included studies,more high quality studies required to be verified above conclusions.
引文
1 Tsuyuguchi T, Takada T, Miyazaki M, et al. Stenting and interventional radiology for obstructive jaundice in patients with unresectable biliary tract carcinomas. J Hepatobiliary Pancreat Surg, 2008, 15(1):69-73.
2 Kurniawan J, Hasan I, Gani RA, et al. Mortality-related factors in patients with malignant obstructive jaundice. Acta Med Indones,2016, 48(4):282-288.
3 American Society for Gastrointestinal Endoscopy. The role of ERCP in diseases of the biliary tract and pancreas:ASGE guidelines for clinical application. Gastrointest Endosc, 1999, 50(6):915-920.
4 Cote GA, Singh S, Bucksot LG, et al. Association between volume of endoscopic retrograde cholangiopancreatography at an academic medical center and use of pancreatobiliary therapy. Clin Gastroenterol Hepatol, 2012,10(8):920-924.
5 Khan MA, Akbar A, Baron TH, et al. Endoscopic ultrasoundguided biliary drainage:a systematic review and meta-analysis. Dig Dis Sci, 2016, 61(3):684-703.
6 Oh HC, Lee SK, Lee TY, et al. Analysis of percutaneous transhepatic cholangioscopy-related complications and the riskfactors for those complications. Endoscopy, 2007, 39(8):731-736.
7 Giovannini M, Moutardier V, Pesenti C, et al. Endoscopic ultrasound-guided bilioduodenal anastomosis:a new technique for biliary drainage. Endoscopy, 2001, 33(10):898-900.
8 Artifon EL, Aparicio D, Paione JB, et al. Biliary drainage in patients with unresectable, malignant obstruction where ERCP fails:endoscopic ultrasonography-guided choledochoduodenostomy versus percutaneous drainage. J Clin Gastroenterol, 2012, 46(9):768-774.
9 Lee TH, Choi JH, Park do H, et al. Similar efficacies of endoscopic ultrasound-guided transmural and percutaneous drainage for malignant distal biliary obstruction. Clin Gastroenterol Hepatol,2016, 14(7):1011-1019.
10黄平,张筱凤,吕文,等.内镜超声下胆道引流在经内镜逆行胰胆管造影失败的恶性梗阻性黄疸中的价值.中华消化内镜杂志,2017, 34(4):246-249.
11 Bapaye A, Dubale N, Aher A. Comparison of endosonographyguided vs. percutaneous biliary stenting when papilla is inaccessible for ERCP. United European Gastroenterol J, 2013,1(4):285-293.
12 Khashab MA, Valeshabad AK, Afghani E, et al. A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Dig Dis Sci, 2015, 60(2):557-565.
13 Bill JG, Darcy M, Fujii-Lau LL, et al. A comparison between endoscopic ultrasound-guided rendezvous and percutaneous biliary drainage after failed ERCP for malignant distal biliary obstruction. Endosc Int Open, 2016, 4(9):E980-E985.
14 Sportes A, Camus M, Greget M, et al. Endoscopic ultrasoundguided hepaticogastrostomy versus percutaneous transhepaticdrainage for malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography:a retrospective expertisebased study from two centers. Therap Adv Gastroenterol, 2017,10(6):483-493.
15 Torres-Ruiz MF, De La Mora-Levy JG, Alonso-Larraga JO, et al.Biliary drainage in malignant obstruction:a comparative study between EUS-guided vs percutaneous drainage in patients with failed ERCP. Gastrointest Endosc, 2016, 83(5, Supplement):AB356.
16 Ogura T, Okuda A, Miyano A, et al. EUS-guided versus percutaneous biliary access in patients with obstructive jaundice due to gastric cancer. Dig Liver Dis, 2018 Sep 22. pii:S1590-8658(18)30985-X. doi:10.1016/j.dld.2018.09.015.
17 Chan SM, Teoh AY. Endoscopic ultrasound-guided biliary drainage:a review. Curr Treat Options Gastroenterol, 2015, 13(2):171-184.
18李振峰,霍仁杰,谢彦涛.不能手术切除的恶性梗阻性黄疸68例治疗体会.中国普外基础与临床杂志,2012, 19(4):443-445.
19 Romagnuolo J, Cotton PB, Eisen G, et al. Identifying and reporting risk factors for adverse events in endoscopy. PartⅡ:noncardiopulmonary events. Gastrointest Endosc, 2011, 73(3):586-597.
20 Nennstiel S, Weber A, Frick G, et al. Drainage-related complications in percutaneous transhepatic biliary drainage:an analysis over 10 years. J Clin Gastroenterol, 2015, 49(9):764-770.
21龚建平,程瑶.恶性梗阻性黄疸术前减黄的标准、指征及效果.中国普外基础与临床杂志,2018, 25(7):781-783.
2 Kurniawan J, Hasan I, Gani RA, et al. Mortality-related factors in patients with malignant obstructive jaundice. Acta Med Indones,2016, 48(4):282-288.
3 American Society for Gastrointestinal Endoscopy. The role of ERCP in diseases of the biliary tract and pancreas:ASGE guidelines for clinical application. Gastrointest Endosc, 1999, 50(6):915-920.
4 Cote GA, Singh S, Bucksot LG, et al. Association between volume of endoscopic retrograde cholangiopancreatography at an academic medical center and use of pancreatobiliary therapy. Clin Gastroenterol Hepatol, 2012,10(8):920-924.
5 Khan MA, Akbar A, Baron TH, et al. Endoscopic ultrasoundguided biliary drainage:a systematic review and meta-analysis. Dig Dis Sci, 2016, 61(3):684-703.
6 Oh HC, Lee SK, Lee TY, et al. Analysis of percutaneous transhepatic cholangioscopy-related complications and the riskfactors for those complications. Endoscopy, 2007, 39(8):731-736.
7 Giovannini M, Moutardier V, Pesenti C, et al. Endoscopic ultrasound-guided bilioduodenal anastomosis:a new technique for biliary drainage. Endoscopy, 2001, 33(10):898-900.
8 Artifon EL, Aparicio D, Paione JB, et al. Biliary drainage in patients with unresectable, malignant obstruction where ERCP fails:endoscopic ultrasonography-guided choledochoduodenostomy versus percutaneous drainage. J Clin Gastroenterol, 2012, 46(9):768-774.
9 Lee TH, Choi JH, Park do H, et al. Similar efficacies of endoscopic ultrasound-guided transmural and percutaneous drainage for malignant distal biliary obstruction. Clin Gastroenterol Hepatol,2016, 14(7):1011-1019.
10黄平,张筱凤,吕文,等.内镜超声下胆道引流在经内镜逆行胰胆管造影失败的恶性梗阻性黄疸中的价值.中华消化内镜杂志,2017, 34(4):246-249.
11 Bapaye A, Dubale N, Aher A. Comparison of endosonographyguided vs. percutaneous biliary stenting when papilla is inaccessible for ERCP. United European Gastroenterol J, 2013,1(4):285-293.
12 Khashab MA, Valeshabad AK, Afghani E, et al. A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Dig Dis Sci, 2015, 60(2):557-565.
13 Bill JG, Darcy M, Fujii-Lau LL, et al. A comparison between endoscopic ultrasound-guided rendezvous and percutaneous biliary drainage after failed ERCP for malignant distal biliary obstruction. Endosc Int Open, 2016, 4(9):E980-E985.
14 Sportes A, Camus M, Greget M, et al. Endoscopic ultrasoundguided hepaticogastrostomy versus percutaneous transhepaticdrainage for malignant biliary obstruction after failed endoscopic retrograde cholangiopancreatography:a retrospective expertisebased study from two centers. Therap Adv Gastroenterol, 2017,10(6):483-493.
15 Torres-Ruiz MF, De La Mora-Levy JG, Alonso-Larraga JO, et al.Biliary drainage in malignant obstruction:a comparative study between EUS-guided vs percutaneous drainage in patients with failed ERCP. Gastrointest Endosc, 2016, 83(5, Supplement):AB356.
16 Ogura T, Okuda A, Miyano A, et al. EUS-guided versus percutaneous biliary access in patients with obstructive jaundice due to gastric cancer. Dig Liver Dis, 2018 Sep 22. pii:S1590-8658(18)30985-X. doi:10.1016/j.dld.2018.09.015.
17 Chan SM, Teoh AY. Endoscopic ultrasound-guided biliary drainage:a review. Curr Treat Options Gastroenterol, 2015, 13(2):171-184.
18李振峰,霍仁杰,谢彦涛.不能手术切除的恶性梗阻性黄疸68例治疗体会.中国普外基础与临床杂志,2012, 19(4):443-445.
19 Romagnuolo J, Cotton PB, Eisen G, et al. Identifying and reporting risk factors for adverse events in endoscopy. PartⅡ:noncardiopulmonary events. Gastrointest Endosc, 2011, 73(3):586-597.
20 Nennstiel S, Weber A, Frick G, et al. Drainage-related complications in percutaneous transhepatic biliary drainage:an analysis over 10 years. J Clin Gastroenterol, 2015, 49(9):764-770.
21龚建平,程瑶.恶性梗阻性黄疸术前减黄的标准、指征及效果.中国普外基础与临床杂志,2018, 25(7):781-783.