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

Abstract

BackgroundIn 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.MethodsStudies 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).ResultsInitial 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).ConclusionsIn 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.

Perioperative antibiotherapy should replace prophylactic antibiotics in patients undergoing pancreaticoduodenectomy preceded by preoperative biliary drainage

“…Hyperbilirubinemia is another risk factor for poor surgical outcomes, but it is unclear if preoperative biliary drainage (PBD) improves outcomes. A recent randomized trial/meta‐analysis indicated that PBD increases morbidity and mortality . PBD is indeed associated with contamination of the bile with microbes that are often resistant to conventional prophylactic antibiotics (PAs) and may cause postoperative infectious morbidity .…”

Dual‐center randomized clinical trial exploring the optimal duration of antimicrobial prophylaxis in patients undergoing pancreaticoduodenectomy following biliary drainage

“…Preoperative biliary drainage (PBD) is widely carried out for relieving biliary obstruction, but it is known to cause bile contamination in approximately 80% of patients . However, PBD is still considered indispensable before major hepatobiliary and pancreatic surgeries, as several previous retrospective studies have reported that it reduced morbidity and mortality after PD through improving liver function …”

Comparison of effect between nasobiliary drainage and biliary stenting in malignant biliary obstruction: a systematic review and updated meta-analysis

“…Inclusion criteria were as follows: (1) study subjects: the cases with confirmed MBO, feasible limited operation; (2) original published literature which contained comparison research on the efficacy of ENBD and EBS, including randomized controlled studies, prospective observational studies, or retrospective observational studies; (3) the sample size of the study: unlimited; (4) follow-up time: more than 3 months; (5) the language of published literature: English; (6) research type: human studies; (7) research indicators: incidence rates of preoperative cholangitis, preoperative pancreatitis, stent dysfunction, morbidity, and postoperative pancreatic fistula.…”

“…Most patients with MBO diseases have obstructive jaundice of varying degrees. Preoperative biliary drainage (PBD) is needed to improve liver function, coagulation function, nutritional status, and immune function in order to avoid acute cholangitis and promote liver regeneration, as well as reducing the risk of operative and postoperative complications [2][3][4]. Common PBD methods include endoscopic biliary stent (EBS), endoscopic nasobiliary drainage (ENBD), and percutaneous transhepatic biliary drainage (PTBD).…”