Comparison of effect between nasobiliary drainage and biliary stenting in malignant biliary obstruction: a systematic review and updated meta-analysis

BACKGROUND: To compare the efficacy of endoscopic nasobiliary drainage (ENBD) and endoscopic biliary stenting (EBS) in preoperative biliary drainage (PBD). METHODS: ENBD and EBS related literature of patients with malignant biliary obstruction published before September 2019 were collected from PubMed, EMBASE, and Cochrane Library for comparison analysis. Revman 5.3 statistical software was used for analysis. RESULTS: Nine studies were used for our comparative study. A total of 1435 patients were included, which consisted of 813 in the ENBD group and 622 in the EBS group. Meta-analysis showed that patients with malignant biliary obstruction who received ENBD had reductions in the rates of preoperative cholangitis (RR = 0.46, 95% CI = 0.34–0.62, P < 0.00001), preoperative pancreatitis (RR = 0.69, 95% CI = 0.50–0.95, P = 0.02), stent dysfunction (RR = 0.58, 95% CI = 0.43–0.80, P = 0.0008), morbidity (RR = 0.77, 95% CI = 0.64–0.93, P = 0.007), and postoperative pancreatic fistula (RR = 0.65, 95% CI = 0.45–0.92, P = 0.02) compared with patients who received EBS. CONCLUSIONS: The rates of preoperative cholangitis, preoperative pancreatitis, post-operative pancreatic fistula, stent dysfunction, and morbidity of ENBD patients were lower than those of EBS patients. In clinical practice, the physical condition of each patient and their tolerance should be fully considered. ENBD should be given priority. EBS should be replaced if stent dysfunction or intolerance occurs.