TY - JOUR
T1 - Stent versus balloon dilation for the treatment of dominant strictures in primary sclerosing cholangitis
T2 - A systematic review and meta-analysis
AU - Ferreira, Marina Tucci Gammaro Baldavira
AU - Ribeiro, Igor Braga
AU - de Moura, Diogo Turiani Hourneaux
AU - McCarty, Thomas R.
AU - da Ponte Neto, Alberto Machado
AU - Farias, Galileu Ferreira Ayala
AU - de Miranda Neto, Antônio Afonso
AU - de Oliveira, Pedro Victor Aniz Gomes
AU - Bernardo, Wanderley Marques
AU - de Moura, Eduardo Guimarães Hourneaux
N1 - Publisher Copyright:
Copyright © 2021 Korean Society of Gastrointestinal Endoscopy
PY - 2021/11
Y1 - 2021/11
N2 - Background/Aims: The endoscopic management of primary sclerosing cholangitis (PSC)-associated dominant strictures remains challenging. This systematic review and meta-analysis aimed to compare balloon dilation and stent placement in the treatment of dominant strictures among PSC patients. Methods: Literature searches on MEDLINE, EMBASE, Cochrane CENTRAL and Lilacs/Bireme were performed for studies published until December 2020. Measured outcomes included clinical efficacy, stricture recurrence, cumulative recurrencefree rate, transplant rate, 5-year survival rate, and adverse events (i.e., pancreatitis, cholangitis, bleeding, perforation and death). Results: A total of 5 studies (n=467) were included. Based on pooled analyses, there were no differences in clinical efficacy (risk difference [RD], -0.13; 95% confidence interval [CI], -0.58 to 0.33; I2=93%) or transplant rates (RD, -0.09; 95% CI, -0.19 to 0.01; I2=0%); however, the risk of occurrence of adverse events was lower with balloon dilatation than with stent placement (RD, -0.34; 95% CI, -0.45 to -0.23; I2=61%). Among the types of adverse events reported, only the rates of cholangitis/bacteremia were significantly lower in balloon dilation patients (RD, -0.19; 95% CI, -0.25 to -0.13; I2=51%). Conclusions: Compared to balloon dilation, stent placement for dominant strictures in PSC appeared to have higher complication rates without significant differences in efficacy.
AB - Background/Aims: The endoscopic management of primary sclerosing cholangitis (PSC)-associated dominant strictures remains challenging. This systematic review and meta-analysis aimed to compare balloon dilation and stent placement in the treatment of dominant strictures among PSC patients. Methods: Literature searches on MEDLINE, EMBASE, Cochrane CENTRAL and Lilacs/Bireme were performed for studies published until December 2020. Measured outcomes included clinical efficacy, stricture recurrence, cumulative recurrencefree rate, transplant rate, 5-year survival rate, and adverse events (i.e., pancreatitis, cholangitis, bleeding, perforation and death). Results: A total of 5 studies (n=467) were included. Based on pooled analyses, there were no differences in clinical efficacy (risk difference [RD], -0.13; 95% confidence interval [CI], -0.58 to 0.33; I2=93%) or transplant rates (RD, -0.09; 95% CI, -0.19 to 0.01; I2=0%); however, the risk of occurrence of adverse events was lower with balloon dilatation than with stent placement (RD, -0.34; 95% CI, -0.45 to -0.23; I2=61%). Among the types of adverse events reported, only the rates of cholangitis/bacteremia were significantly lower in balloon dilation patients (RD, -0.19; 95% CI, -0.25 to -0.13; I2=51%). Conclusions: Compared to balloon dilation, stent placement for dominant strictures in PSC appeared to have higher complication rates without significant differences in efficacy.
KW - Balloon dilation
KW - Dominant stricture
KW - Primary sclerosing cholangitis
KW - Stent
UR - http://www.scopus.com/inward/record.url?scp=85121120024&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85121120024&partnerID=8YFLogxK
U2 - 10.5946/ce.2021.052
DO - 10.5946/ce.2021.052
M3 - Article
AN - SCOPUS:85121120024
SN - 2234-2400
VL - 54
SP - 833
EP - 842
JO - Clinical Endoscopy
JF - Clinical Endoscopy
IS - 6
ER -