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Original Article
 
Endoscopic palliative treatment versus surgical bypass in malignant low bile duct obstruction: A systematic review and meta-analysis
Silvia Lucia Alves de Lima1, Fabio Alberto Castillo Bustamante1, Eduardo GuimarãesHourneaux de Moura2, Wanderley Bernardo Marques3, Everson Luiz de Almeida Artifon1, Dalton Marques Chaves1, Tomazo Antonio Prince Franzini1, Carlos Kiyoshi Furuya Junior1
1MD Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of Sao Paulo Medical School. São Paulo, São Paulo, Brazil.
2Head Teacher Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of Sao Paulo Medical School. São Paulo, São Paulo, Brazil.
3Methodological Adviser Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of Sao Paulo Medical School. São Paulo, São Paulo, Brazil

Article ID: 100032IJHPDSL2015
doi:10.5348/ijhpd-2015-32-CR-7

Address correspondence to:
Fabio Alberto Castillo Bustamante
MD, Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of Sao Paulo Medical School
São Paulo, São Paulo
Brazil
Adress Av DrEnéas de carvalhoAguiar 255 andarbloco 03, Postal Code 05403900
Phone: 1126616221
Fax: 1126616463

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How to cite this article
Alves de Lima SL, Bustamante FAC, Hourneaux de Moura EG, Bernardo WM, Artifon ELA, Chaves DM, Franzini TAP, Junior CKF. Endoscopic palliative treatment versus surgical bypass in malignant low bile duct obstruction: A systematic review and meta-analysi. Int J Hepatobiliary Pancreat Dis 2015;5:35–45.


Abstract
Aims: Despite technological advances, only about 20% of periampullary tumors are found to be resectable at the time of presentation. Biliary tree obstruction and consequent jaundice occur in 70–90% of those patients and has important consequences for a patient's quality of life. Relief of biliary tree obstruction is the main goal for treatment, and few options for palliative therapy of biliary tree obstruction can be performed, including surgical bypass, percutaneous stenting, and endoscopic stenting.
Objective: The aim of the present study was to acquire and analyze data to compare the success of procedures, procedure-related complication, mortality in 30 days, recurrent-jaundice rates in endoscopic, and surgical palliative techniques. Methods: Two independent reviewers searched the following electronic databases: Medline, EMBASE, Cochrane, LILACS, BVS, SCOPE, and CINAHL (EBSCO). Inclusion criteria included studies involving patients with distal biliary obstruction due to periampullary tumors who underwent endoscopic therapy or a surgical procedure for palliation.
Results: No differences were observed for success of procedures; differences were observed with better outcomes for endoscopy therapy with regards to mortality associated with procedure, complication associated with procedure, and mortality in 30 days. Also, differences were observed with better outcomes for surgery therapy for recurrent-jaundice.
Conclusion: Endoscopic palliative drainage is associated with a lower rate in complication, mortality associated with procedure, and mortality in 30 days. Recurrent-jaundice analysis demonstrated an overall lower rate in surgical bypass procedures. No differences were found for the success of procedures.

Keywords: Periampullary tumors, Bile duct cancer, Cholangiocarcinoma, Pancreatic carcinoma, Endoscopy, Gastrointestinal, Surgical procedures

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Author Contributions:
Silvia Lucia Alves de Lima – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Fabio Alberto Castillo Bustamante – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Eduardo GuimarãesHourneaux de Moura – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Wanderley Bernardo Marques – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Everson Luiz de Almeida Artifon – Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Dalton Marques Chaves – Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Tomazo Antonio Prince Franzini – Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Carlos Kiyoshi Furuya Junior – Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Waqas Jehangir et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

Silvia Lucia Alves de Lima MD Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of Sao Paulo Medical School. São Paulo, São Paulo, Brazil. She earned the undergraduate degree MD from BotucatuMedical School, São Paulo, São Paulo, Brazil. and postgraduate degree in Gastrointestinal Surgery from Hospital das Clinicas, University of Sao Paulo Medical School. São Paulo, São Paulo, Brazil. Fellow, Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of Sao Paulo Medical School. São Paulo, São Paulo, Brazil. His research interests include Gastrointestinal Endoscopy Gastrointestinal Surgery Diagnosis and Treatment of pancreatic and biliary pathologies.



Fabio Alberto Castillo Bustamante MD Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of Sao Paulo Medical School. São Paulo, São Paulo, Brazil. He earned the undergraduate degree MD from Universidad Nacional de Colombia, Bogota, Colombia and postgraduate degree inGeneral Surgeon from General Surgery Department, Universidad El Bosque, Bogotá, Colombia. Fellow, Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of Sao Paulo Medical School. São Paulo, São Paulo, Brazil. His research interests include Gastrointestinal Endoscopy Gastrointestinal Surgery Treatment of Early Neoplasia Digestive System Diagnosis and Treatment of pancreatic and biliary pathologies. He intends to pursuePhD'sin future



Eduardo Guimarães Hourneaux de Moura is Graduated in Medicine, Faculty of Medical and Health Sciences from the Catholic University of São Paulo (1984), Master in Medicine by the Brazilian Institute of Studies and Gastroenterology Research - IBEPEGE (1985), Doctorate in Medicine from the University of Medicine São Paulo - USP (2000) and Full Professor at the Faculty of Medicine, University of São Paulo (2012). He is currently Director of the Gastrointestinal Endoscopy Service and Broncoesofagoscopia the Hospital das Clínicas, Advisor of the Graduate Program of Science in USP of Gastroenterology, Medical Associate Professor in the Department of Digestive Surgery, Department apparatus. of USP Gastroenterology, Supervisor of the Medical Residency Program in the Endoscopy Coreme-USP.



Wanderley Marques Bernardo is Graduated in Medicine, Faculty of Medical Sciences of Santos (1984) and a PhD in thoracic Surgery, Faculty of Medicine, University of São Paulo (2003). He is currently coordinator of the Knowledge Center, Faculty of Medicine, University of Sao Paulo, Coordinator of the Program Guidelines of the Brazilian Medical Association and the Federal Council of Medicine; Professor Doctor University Center Lusiada, Medical School. Has experience in the area of medicine, with an emphasis on evidence-based medicine, acting on the following subjects: evidence-based medicine, medical guidelines, systematic reviews, clinical decision, practice guidelines and Technology Assessment.



Everson Luiz de Almeida Artifon is Graduated in Medicine from the Federal University of Paraná (1994), specialization in Title Specialist In Chirurgie Dig by the Brazilian College of Digestive Surgery (1997), specialization Specialist in General Surgery by the Brazilian College of Surgeons (1998) specialization in the Title In Digestive Endoscopy by the Brazilian Society of Digestive Endoscopy (2001), Master of Medicine (Digestive System Surgery), University of São Paulo (2001), PhD in Medicine (Surgery of the Digestive System), University of São Paulo (2004), post-doctorate from the Faculty of Medicine, USP (2005), residence-doctors from the University of São Paulo (2001) and residence-doctors from the State University of Campinas (1998). He is currently Head of the Hospital Ana Costa Service, Chief of Endoscopy Service of the Hospital Ana Costa, Hospital Medical AlemãoOswaldo Cruz, Assistant Physician, Hospital of the School of USP, Physician Hospital Assistant of the School of Medicine Clinics University of São Paulo.



Dalton Marques Chaves is Graduated in Medicine from the Federal University of Uberlândia (1986), specializing in Endoscopy, Digestive System by the Hospital of the USP (1991), master's degree from the University of São Paulo (1995), Doctorate of Science (Human Physiology) from the University of St. Paul (2001), post-doctorate from the California Pacific Medical Center (2004) and residence-doctors from the Federal University of Uberlândia (1989). He is currently Medical Endoscopy Service of the Hospital of the USP, Member of the Brazilian Society of Digestive Endoscopy, Member of the Regional Council of Medicine of São Paulo, Medical EndoscopistFleury Group, Member of The American Society for Gastrointestinal Endoscopy and regular reviewer of Gastrointestinal Endoscopy.



Tomazo Antonio Prince Franzini is Graduated in Medicine from the University of Mogi das Cruzes, Medical residency in general surgery by FMABC, Specialization in Gastrointestinal Endoscopy at HCFMUSP, Specialist in Endoscopy by SOBED, international Member of the ASGE (American Society of Gastrointestinal Endoscopy). PhD in Sciences in Gastroenterology at the Faculty of Medicine, University of São Paulo. He is currently assistant physician endoscopist HCFMUSP University of São Paulo, endoscopist doctor Unimed Limeira Hospital and medical endoscopy, Hospital São Luiz-Morumbi / Jabalpur - SP.



Carlos Kiyoshi Furuya Junior is MD Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of Sao Paulo Medical School. São Paulo, São Paulo. Extensâouniversitáriaem ENDOSCOPIA. Universidade de São Paulo, USP, Brasil.