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KMID : 1038120210540060833
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Clinical Endoscopy
2021 Volume.54 No. 6 p.833 ~ p.842
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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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Ferreira Marina Tucci Gammaro Baldavira
Ribeiro Igor Braga
De Moura Diogo Turiani Hourneaux
McCarty Thomas R.
da Ponte Neto Alberto Machado
Farias Galileu Ferreira Ayala
de Miranda Neto Antonio Afonso
de Oliveira Pedro Victor Aniz Gomes
Bernardo Wanderley Marques
De Moura Eduardo Guimaraes Hourneaux
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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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KEYWORD
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Balloon dilation, Dominant stricture, Primary sclerosing cholangitis, Stent
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