Clin Endosc.  2021 Nov;54(6):833-842. 10.5946/ce.2021.052.

Stent versus Balloon Dilation for the Treatment of Dominant Strictures in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis

• Ferreira MTGB
• Ribeiro IB
• de Moura DTH
• McCarty TR
• da Ponte Neto AM
• Farias GFA
• de Miranda Neto AA
• de Oliveira PVAG
• Bernardo WM
• de Moura EGH

• KMID: 2522703
• DOI: http://doi.org/10.5946/ce.2021.052

Abstract

Background/Aims
The endoscopic management of primary sclerosing cholangitis (PSC)-associated dominant strictures remains challenging. This systematic review and meta-analysis aimed to compare balloon dilation and stent placement in the treatment of dominant strictures among PSC patients.
Methods
Literature searches on MEDLINE, EMBASE, Cochrane CENTRAL and Lilacs/Bireme were performed for studies published until December 2020. Measured outcomes included clinical efficacy, stricture recurrence, cumulative recurrencefree rate, transplant rate, 5-year survival rate, and adverse events (i.e., pancreatitis, cholangitis, bleeding, perforation and death).
Results
A total of 5 studies (n=467) were included. Based on pooled analyses, there were no differences in clinical efficacy (risk difference [RD], -0.13; 95% confidence interval [CI], -0.58 to 0.33; I²=93%) or transplant rates (RD, -0.09; 95% CI, -0.19 to 0.01; I²=0%); however, the risk of occurrence of adverse events was lower with balloon dilatation than with stent placement (RD,-0.34; 95% CI, -0.45 to -0.23; I²=61%). Among the types of adverse events reported, only the rates of cholangitis/bacteremia were significantly lower in balloon dilation patients (RD, -0.19; 95% CI, -0.25 to -0.13; I²=51%).
Conclusions
Compared to balloon dilation, stent placement for dominant strictures in PSC appeared to have higher complication rates without significant differences in efficacy.

Keyword

Balloon dilation; Dominant stricture; Primary sclerosing cholangitis; Stent

Figure

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  Fig. 1. Flow chart of study selection. *: Narrative reviews (9), guidelines (2) and case reports (4)

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  Fig. 2. Stent × ballon dilation. (A) Forest plot of clinical efficacy. (B) Forest plot of transplant rate. CI, confidence interval.

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  Fig. 3. Stent × ballon dilation adverse events. (A) Forest plot of total adverse events. (B) Forest plot of cholangitis/bacteremia. (C) Forest plot of pancreatitis. (D) Forest plot of perforation. (E) Forest plot of cholangiocarcinoma. CI, confidence interval.

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