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Stent versus Balloon Dilation for the Treatment of Dominant Strictures in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis
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Marina Tucci Gammaro Baldavira Ferreira, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Alberto Machado da Ponte Neto, Galileu Ferreira Ayala Farias, Antônio Afonso de Miranda Neto, Pedro Victor Aniz Gomes de Oliveira, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
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Clin Endosc 2021;54(6):833-842. Published online July 1, 2021
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DOI: https://doi.org/10.5946/ce.2021.052
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 Abstract
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- 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.
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Citations
Citations to this article as recorded by  - Treatment of Non-Anastomotic Biliary Strictures after Liver Transplantation: How Effective Is Our Current Treatment Strategy?
Florian A. Michael, Mireen Friedrich-Rust, Hans-Peter Erasmus, Christiana Graf, Olivier Ballo, Mate Knabe, Dirk Walter, Christoph D. Steup, Marcus M. Mücke, Victoria T. Mücke, Kai H. Peiffer, Esra Görgülü, Antonia Mondorf, Wolf O. Bechstein, Natalie Filma
Journal of Clinical Medicine.2023; 12(10): 3491. CrossRef - Treatment of primary sclerosing cholangitis combined with inflammatory bowel disease
You Sun Kim, Edward H. Hurley, Yoojeong Park, Sungjin Ko
Intestinal Research.2023; 21(4): 420. CrossRef - Liver Transplantation for Primary Sclerosing Cholangitis (PSC) With or Without Inflammatory Bowel Disease (IBD)—A European Society of Organ Transplantation (ESOT) Consensus Statement
M. Carbone, A. Della Penna, C. Mazzarelli, E. De Martin, C. Villard, A. Bergquist, P. D. Line, J. M. Neuberger, S. Al-Shakhshir, P. J. Trivedi, U. Baumann, L. Cristoferi, J. Hov, B. Fischler, N. H. Hadzic, D. Debray, L. D’Antiga, N. Selzner, L. S. Belli,
Transplant International.2023;[Epub] CrossRef - Primary Biliary Cholangitis and Primary Sclerosing Cholangitis: Current Knowledge of Pathogenesis and Therapeutics
Ji-Won Park, Jung-Hee Kim, Sung-Eun Kim, Jang Han Jung, Myoung-Kuk Jang, Sang-Hoon Park, Myung-Seok Lee, Hyoung-Su Kim, Ki Tae Suk, Dong Joon Kim
Biomedicines.2022; 10(6): 1288. CrossRef - Use a biodegradable stent in ERCP and it will never be forgotten
Jesús García-Cano, Eva de la Santa Belda, Francisco Domper
Revista Española de Enfermedades Digestivas.2022;[Epub] CrossRef - Endoscopic stenting of dominant strictures in patients with primary sclerosing cholangitis: When, how, and for how long?
Il Sang Shin, Jong Ho Moon
Endoscopy International Open.2022; 10(09): E1169. CrossRef
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