The efficacy and safety of 125I seeds combined with biliary stent placement versus stent placement alone for malignant biliary obstruction: a systematic review and meta-analysis

BackgroundCurrently, it is unknown whether iodine-125 (125I) stent implantation has the same therapeutic effect on patients with malignant biliary obstruction (MBO) caused by different cancers. This meta-analysis aimed to investigate whether 125I implantation in patients with MBO is superior to biliary stent placement in efficacy and safety, and to further explore the difference in efficacy and safety of seed implantation in different patients through subgroup analysis. MethodsA systematic search of the PubMed, Wiley Online Library, Cochrane library, Google Scholar, the Web of Science, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases was conducted to screen all relevant studies up to October 30, 2022. Articles were not subjected to language or geographical limitations, but were required to meet the inclusion and exclusion criteria for this study. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of articles. The primary endpoint was survival, which was defined as the interval between initial treatment and death or the end of study. Meta analysis was performed using Stata/SE15.0. ResultsA total of 12 eligible studies were enrolled including 679 patients. All the included studies were single-center studies carried out in China. The results showed that the death risk and stent occlusion risk in the 125I group was 0.441 times [95% confidence interval (CI): 0.315 to 0.619, P0.05). ConclusionsFor patients with MBO caused by hilar tumor or other tumors, 125I seed implantation can reduce the death risk and stent occlusion risk, prolong the time of survival and stent patency, and does not increase the complication risk. Due to the limitations of the study populat