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

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). 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. 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. 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.