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Biliary Stent with 125I Seeds vs. Simple Biliary Stent for Malignant Obstructive Jaundice: A Systematic Review and Meta-Analysis

Aim: To assess the safety, feasibility and efficacy of 125I seeds irradiation stents compared with conventional selfexpandable metal stents (SEMS) to treat malignant obstructive jaundice (MOJ).

Methods: A systematic search of English and Chinese databases, from January 1980 to December 2017, was conducted. All prospective random trials comparing SEMS and the various form of irradiation stent with 125I seeds to treat MOJ were included.

Results: Overall, six studies with 276 patients were eligible in current analysis. Of reported 276 patients, 138 patients were subjected to irradiation stents while 138 patients to SEMS. The irradiation stents are associated with a longer survival (hazard ratio (HR) 0.46, IV, random, 95% confidence interval (CI) 0.34-0.63; p<0.001, I2=0%) and stent patency (HR 0.45, IV, random, 95% CI 0.25-0.80; p=0.007, I2=59%) than conventional SEMS.

There are no differences in total complications rate (relative risk (RR) 0.75, M-H, random, 95% CI 0.41-1.38; p=0.35, I2=0%), hemobilia (RR 0.34, M-H, random, 95% CI 0.07-1.64; p=0.18, I2=0%), pain (RR 0.87, M-H, random, 95% CI 0.29-2.61; p=0.80, I2=0%), and cholangitis (RR 1.33, M-H, random, 95% CI 0.32-5.48; p=0.69, I2=0%).

Also, no differences were observed in all indexes, which included total bilirubin (TBIL) (weighted mean difference (WMD) -5.52, IV, random, 95% CI -20.58-9.54; p=0.47, I2=33%), direct bilirubin (DBIL) (WMD 7.38, IV, random, 95% CI -8.00-22.75; p=0.35, I2=0%), alanine aminotransferase (ALT) (WMD 2.76, IV, random, 95% CI -14.05-19.57; p=0.75, I2=64%), aspartate aminotransferase (AST) (WMD 9.49, IV, random, 95% CI -9.31-28.29; p=0.35, I2=0%).

Conclusions: According to limited source data, the current meta-analysis suggests that the irradiation stent is a feasible, safe treatment of MOJ, with longer survival and stent patency. Application of irradiation stent with antitumor effect does not add extra adverse events compared to SEMS stent.


Hao Zhang, Shadike Apaer, Li Yu-peng and Tuerhongjiang Tuxun

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