Unilateral Versus Side-By-Side Metal Stenting for Malignant Hilar Biliary Obstruction: A Meta-analysis

Purpose:The present meta-analysis was designed to compare the relative clinical efficacy of unilateral and side-by-side metal stenting for the treatment of malignant hilar biliary obstruction (MHBO). Materials and Methods:The PubMed, Embase, and Cochrane Library databases were searched to identify all relevant studies published as of May 2020. This meta-analysis was conducted using RevMan v5.3, and relevant endpoint data pertaining to rates of technical and clinical success, overall survival, complications, and stent dysfunction were extracted from all studies. Results:In total, we identified seven relevant studies that were included in the present meta-analysis, with these studies including 683 total MHBO patients who were treated via either unilateral (n = 366) or side-by-side bilateral (n = 317) metal stenting. We observed no significant differences between these two groups with respect to technical success rates (odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.40-1.63,P = .56) or overall survival (hazard ratio: 1.03; 95% CI: 0.83-1.28,P = .79). However, the side-by-side group exhibited significantly higher clinical success (OR: 3.56; 95% CI: 1.62-7.82,P = .002) and stent patency (OR: 1.74; 95% CI: 1.16-2.61,P = .007) rates, whereas complication rates trended toward being lower in the unilateral group (OR: 0.51; 95% CI: 0.30-1.00,P = .05). No significant heterogeneity among included studies was detected for any of these endpoints. Conclusion:These results suggest that side-by-side metal stenting can yield better clinical success rates and a reduced incidence of stent dysfunction compared with unilateral stenting in MHBO patients.