Unilateral Vs Bilateral Plastic Stenting for Malignant Hilar Stricture: a Meta-Analysis and Systematic Review of Risks
Srinivas R. Puli*1, Matthew L. Bechtold1, Jyotsna Bk Reddy1, Mainor R. Antillon1, David L. Carr-Locke2
1Department of Gastroenterology and Hepatology, University of Missouri - Columbia, Columbia, MO; 2The Endoscopy Institute, Brigham & Women's Hospital, Boston, MA
Backgound: Plastic stents are used for palliating inoperable malignant hilar strictures. It is unclear if bilateral plastic stenting provides any advantage over unilateral stentingAim: To compare bilateral and unilateral plastic stenting in malignant hilar strictures.Method:Study Selection Criteria: Studies using plastic stents for palliation in patients with malignant hilar stricture. Data collection & extraction: Articles searched in Medline, Pubmed, Japanese language literature, Ovid journals, CINAH, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane Central Register of Controlled Trials & Database of Systematic Reviews. Two reviewers independently searched and extracted data.Statistical Method: Pooled proportions were calculated using Mantel-Haenszel method (fixed effects model) and by the DerSimonian Laird method (random effects model). The heterogeneity among studies was tested using Cochran’s Q test based upon inverse variance weights.Results: 1540 reference articles were identified, of which 129 were selected and reviewed. 8 studies (N=367) for bilateral plastic stenting and 8 studies (N=850) for unilateral plastic stenting which met the inclusion criteria were included in this analysis. Pooled data are shown in table 1. The pooled estimated by fixed and random effect models were similar. The p for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10.Conclusions: Unilateral plastic stenting seems to have similar odds of overall complications, cholangitis, and 30 day mortality when compared to bilateral plastic stenting for malignant hilar strictures. In patients with malignant hilar stricture, unilateral plastic stenting is comparable to bilateral plastic stenting for adverse events.
Table 1: Comparison of bilateral plastic vs unilateral plastic stenting for malignant hilar obstruction
| Odds Ratio with 95% CI | p (tests if odds ratio different from 1) | |
| Success of Placement | 0.94 (0.64 to 1.38) | 0.8238 |
| Decrease in Bilirubin | 2.29 (0.67 to 7.81) | 0.1871 |
| Overall Complications | 1.42 (0.21 to 9.33) | 0.7177 |
| Early Complications | 1.54 (0.92 to 2.59) | 0.1266 |
| Overall Cholangitis | 1.46 (0.68 to 3.16) | 0.3331 |
| Early Cholangitis | 2.19 (0.64 to 7.57) | 0.2131 |
| Late Cholangitis | 1.26 (0.06 to 24.74) | 0.879 |
| 30 Day Mortality | 0.78 (0.38 to 1.61) | 0.5066 |
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