A Systematic Review and Meta-Analysis of Preoperative Biliary Drainage Methods in Periampullary Tumors

Background: Pancreatic and hepatobiliary tumors continue to rank among the deadliest cancers worldwide. Due to a low response rate to treatment, these tumors continue to have a high death rate, a poor prognosis and survival rate, and an overall poor patient outcome. The multimodal strategy used in current treatment includes systemic therapy, radiation therapy, and surgery. However, surgery remains the only treatment with curative intent. Preoperative biliary drainage has a direct impact on the perioperative prognosis of patients with obstructive jaundice and significantly compromised liver function due to hepato-bilio-pancreatic malignancies. Our study's goal was to determine the safest and most efficient preoperative biliary drainage technique by conducting a systematic review and meta-analysis of resectable periampullary cancers. Methods: Our approach consisted of searching PubMed, BMC Medicine, and Scopus databases using keywords with a result of 1104 articles from 2010 to 2023. The remaining 24 articles that met our inclusion criteria were subjected to meta-analysis using R Commander 4.3.2. Results: Endoscopic retrograde biliary drainage (ERBD) demonstrated a higher rate of postprocedural pancreatitis (RR = 2.22, p < 0.01), intra-abdominal abscess (RR = 1.64, p < 0.01), and delayed gastric emptying (DGE) (RR = 2.07, p < 0.01) than percutaneous transhepatic biliary drainage (PTBD) or endoscopic nasobiliary drainage (ENBD). Plastic stent (PS) had higher rates of catheter occlusion (RR = 2.20, p < 0.01) and POPF (RR = 1.66, p < 0.01) compared to self-expandable metallic stent (SEMS), which could explain a longer hospital stay (MD = 2.41 days, p < 0.01). However, PS had lower rates of grade 1-2 complications (RR = 0.79, p = 0.017) and wound infection rates (RR = 0.66, p = 0.017) than self-expandable metallic stent (SEMS). Conclusions: The choice of a preoperative drainage method can influence postprocedural and postoperative complications rates. ERBD appears to be associated with higher procedure-related and postoperative complication rates and may be linked to a prolonged hospital stay compared to ENBD or PTBD. Moreover, the type of stent placed through ERBD procedure had an important impact on prognosis, as PS had a higher rate of catheter occlusion and POPF, with a prolonged hospital stay compared to SEMS, while mild complications and wound infections were less common in PS group.