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Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review.

Moole H, Bechtold M, Puli SR - World J Surg Oncol (2016)

Bottom Line: Pooled number of major adverse effects was lower in the PBD group at 10.40 (95 % CI = 9.96 to 10.83) compared to 15.56 (95 % CI = 15.06 to 16.05) in the DS group.Subgroup analysis comparing internal PBD to DS group showed lower odds for major adverse events (odds ratio, 0.48 with 95 % CI = 0.32 to 0.74).Length of hospital stay and mortality rate were comparable in both the groups.

View Article: PubMed Central - PubMed

Affiliation: Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA. harsha1778@yahoo.co.in.

ABSTRACT

Background: In patients requiring surgical resection for malignant biliary jaundice, it is unclear if preoperative biliary drainage (PBD) would improve mortality and morbidity by restoration of biliary flow prior to operation. This is a meta-analysis to pool the evidence and assess the utility of PBD in patients with malignant obstructive jaundice. The primary outcome is comparing mortality outcomes in patients with malignant obstructive jaundice undergoing direct surgery (DS) versus PBD. The secondary outcomes include major adverse events and length of hospital stay in both the groups.

Methods: Studies using PBD in patients with malignant obstructive jaundice were included in this study. For the data collection and extraction, articles were searched in MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, etc. Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian-Laird method (random effects model).

Results: Initial search identified 2230 reference articles, of which 204 were selected and reviewed. Twenty-six studies (N = 3532) for PBD in malignant obstructive jaundice which met the inclusion criteria were included in this analysis. The odds ratio for mortality in PBD group versus DS group was 0.96 (95 % CI = 0.71 to 1.29). Pooled number of major adverse effects was lower in the PBD group at 10.40 (95 % CI = 9.96 to 10.83) compared to 15.56 (95 % CI = 15.06 to 16.05) in the DS group. Subgroup analysis comparing internal PBD to DS group showed lower odds for major adverse events (odds ratio, 0.48 with 95 % CI = 0.32 to 0.74).

Conclusions: In patients with malignant biliary jaundice requiring surgery, PBD group had significantly less major adverse effects than DS group. Length of hospital stay and mortality rate were comparable in both the groups.

No MeSH data available.


Related in: MedlinePlus

Forest plot: individual study proportions and the pooled estimate of effect size for overall adverse events in the PBD group
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Fig4: Forest plot: individual study proportions and the pooled estimate of effect size for overall adverse events in the PBD group

Mentions: Major adverse events include pancreatitis, cholangitis, perforation, stent occlusion, pancreaticojejunostomy leakage, gastrojejunostomy leakage, duodenojejunostomy leakage, hemorrhage after ERCP or pancreatectomy, biliary leakage, delayed gastric emptying, myocardial infarction, portal vein thrombosis, wound infection, pneumonia, need for repeated laparotomy, and intraabdominal abscess. Pooled number of major adverse events in preoperative biliary drainage group was 10.40 (95 % CI = 9.96 to 10.83) compared to 15.56 (95 % CI = 15.06 to 16.05) in the direct surgery group. The Begg-Mazumdar indicator gave a Kendall’s tau b value of 0.69 (p = <0.0001) and 0.49 (p = 0.0006) in the PBD and DS groups, respectively. Figures 4 and 5 show the forest plots of the major adverse event effect size in individual studies, in the PBD and DS groups, respectively.Fig. 4


Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review.

Moole H, Bechtold M, Puli SR - World J Surg Oncol (2016)

Forest plot: individual study proportions and the pooled estimate of effect size for overall adverse events in the PBD group
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940848&req=5

Fig4: Forest plot: individual study proportions and the pooled estimate of effect size for overall adverse events in the PBD group
Mentions: Major adverse events include pancreatitis, cholangitis, perforation, stent occlusion, pancreaticojejunostomy leakage, gastrojejunostomy leakage, duodenojejunostomy leakage, hemorrhage after ERCP or pancreatectomy, biliary leakage, delayed gastric emptying, myocardial infarction, portal vein thrombosis, wound infection, pneumonia, need for repeated laparotomy, and intraabdominal abscess. Pooled number of major adverse events in preoperative biliary drainage group was 10.40 (95 % CI = 9.96 to 10.83) compared to 15.56 (95 % CI = 15.06 to 16.05) in the direct surgery group. The Begg-Mazumdar indicator gave a Kendall’s tau b value of 0.69 (p = <0.0001) and 0.49 (p = 0.0006) in the PBD and DS groups, respectively. Figures 4 and 5 show the forest plots of the major adverse event effect size in individual studies, in the PBD and DS groups, respectively.Fig. 4

Bottom Line: Pooled number of major adverse effects was lower in the PBD group at 10.40 (95 % CI = 9.96 to 10.83) compared to 15.56 (95 % CI = 15.06 to 16.05) in the DS group.Subgroup analysis comparing internal PBD to DS group showed lower odds for major adverse events (odds ratio, 0.48 with 95 % CI = 0.32 to 0.74).Length of hospital stay and mortality rate were comparable in both the groups.

View Article: PubMed Central - PubMed

Affiliation: Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA. harsha1778@yahoo.co.in.

ABSTRACT

Background: In patients requiring surgical resection for malignant biliary jaundice, it is unclear if preoperative biliary drainage (PBD) would improve mortality and morbidity by restoration of biliary flow prior to operation. This is a meta-analysis to pool the evidence and assess the utility of PBD in patients with malignant obstructive jaundice. The primary outcome is comparing mortality outcomes in patients with malignant obstructive jaundice undergoing direct surgery (DS) versus PBD. The secondary outcomes include major adverse events and length of hospital stay in both the groups.

Methods: Studies using PBD in patients with malignant obstructive jaundice were included in this study. For the data collection and extraction, articles were searched in MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, etc. Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian-Laird method (random effects model).

Results: Initial search identified 2230 reference articles, of which 204 were selected and reviewed. Twenty-six studies (N = 3532) for PBD in malignant obstructive jaundice which met the inclusion criteria were included in this analysis. The odds ratio for mortality in PBD group versus DS group was 0.96 (95 % CI = 0.71 to 1.29). Pooled number of major adverse effects was lower in the PBD group at 10.40 (95 % CI = 9.96 to 10.83) compared to 15.56 (95 % CI = 15.06 to 16.05) in the DS group. Subgroup analysis comparing internal PBD to DS group showed lower odds for major adverse events (odds ratio, 0.48 with 95 % CI = 0.32 to 0.74).

Conclusions: In patients with malignant biliary jaundice requiring surgery, PBD group had significantly less major adverse effects than DS group. Length of hospital stay and mortality rate were comparable in both the groups.

No MeSH data available.


Related in: MedlinePlus