Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice

Fang, Yirong; Gurusamy, Kurinchi Selvan; Wang, Q; Davidson, Brian R; Lin, Hui; Xie, Xiaohua; C, Wang

doi:10.1002/bjs.9260

Cited by 114 publications

(61 citation statements)

References 39 publications

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“…[5][6][7][8] However, in Japan, preoperative biliary drainage is generally carried out. This is attributed to the fact that appropriately conducted preoperative biliary drainage can decrease the risk of postoperative complications 22 and that surgical waiting time, including detailed preoperative examinations, is usually several weeks.…”

Section: Discussionmentioning

confidence: 99%

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Influence of cholangitis after preoperative endoscopic biliary drainage on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures

Kaneko

Inoue

Kida

et al. 2017

Digestive Endoscopy

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Background and Aim: Preoperative cholangitis after preoperative drainage has been reported to increase postoperative complications, particularly pancreatic fistula. We therefore examined the effects of cholangitis after preoperative endoscopic biliary drainage (EBD) on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures. Methods:The study group comprised 102 patients who underwent EBD among patients who underwent surgery. Results:Of the 102 patients, 33 (32%) had postoperative pancreatic fistulas, and 56 (55%) had preoperative cholangitis after preoperative drainage. Analysis of risk factors for preoperative cholangitis showed that a total bilirubin level of 2.9 mg/dL or higher (hazard ratio [HR], 2.95; 95% confidence interval [CI], 1.223-7.130; P = 0.016) and a surgical waiting time of 29 days or longer (HR, 4.23; 95% CI, 1.681-10.637; P = 0.02) were independent risk factors for cholangitis. Patients with preoperative cholangitis had a significantly higher incidence of pancreatic fistula than did patients without preoperative cholangitis (78.8 vs 21.2%; P = 0.001). Patients with biliary cancer had a significantly higher incidence of pancreatic fistula than did those with pancreatic cancer (72.7 vs 27.2%; P = 0.005). Multivariate analysis showed that preoperative cholangitis (HR, 4.8; 95% CI,; P = 0.001) and biliary cancer (HR, 3.5; 95% CI, 1.335-8.942; P = 0.006) were significant independent risk factors for postoperative pancreatic fistula.Conclusion: Prevention of preoperative cholangitis, a risk factor for postoperative pancreatic fistula, is likely to decrease the incidence of postoperative pancreatic fistula.

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Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8] The development of preoperative cholangitis after preoperative drainage has been reported to increase the incidence of postoperative complications, particularly pancreatic fistula. 9 Pancreatic fistula is a risk factor for surgical site infection.…”

mentioning

confidence: 99%

Influence of cholangitis after preoperative endoscopic biliary drainage on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures

Kaneko

Inoue

Kida

et al. 2017

Digestive Endoscopy

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“…In a recent meta-analysis Y. Fang et al [25] found no strong evidence to support "routine preoperative biliary drainage." Large clinical trials are needed to determine the threshold level of bilirubin that will indicate which patients should undergo biliary drainage before surgery.…”

Section: What Are the Indications For Plastic Versus Metal Stent In Mmentioning

confidence: 98%

Management of Biliary Strictures and Bile Duct Injury

et al. 2015

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“…[40][41][42][43][44][45] Major drawbacks of these meta-analyses are the inclusion of retrospective series, methodological flaws, and the inclusion of patients who underwent percutaneous PBD or endoscopic PBD. Table 2 shows the results of the most recent metaanalyses.…”

Section: Preoperative Biliary Drainage Versus Early Surgerymentioning

confidence: 99%

Stent placement as a bridge to surgery in malignant biliary obstruction (pancreatic cancer, distal bile duct cancer, and hilar tumors)

Rodarte-Shade

Kahaleh

2015

Gastrointestinal Intervention

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a b s t r a c tPreoperative biliary drainage (PBD) has been a matter of controversy for years. It was initially aimed to improve the clinical status of patients with malignant obstructive jaundice prior to surgery. However, its efficacy and safety have not been proven by randomized controlled trials. Most drawbacks of PBD are related to the increase in procedure-related adverse events and inappropriate biliary decompression. Current trends in PBD show that using selfexpanding metallic stents (SEMSs) may reduce the high incidence of stent-related complications with improved outcomes. The aim of this study was to review the current literature regarding PBD in patients with resectable distal pancreaticobiliary and hilar tumors.

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Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice

Abstract: PBD in patients undergoing surgery for obstructive jaundice is associated with similar mortality but increased serious morbidity compared with no PBD. Therefore, PBD should not be used routinely.

Cited by 114 publications

References 39 publications

Influence of cholangitis after preoperative endoscopic biliary drainage on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures

Influence of cholangitis after preoperative endoscopic biliary drainage on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures

Management of Biliary Strictures and Bile Duct Injury

Stent placement as a bridge to surgery in malignant biliary obstruction (pancreatic cancer, distal bile duct cancer, and hilar tumors)

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