Stenting with high-intensity focused ultrasound ablation for distal biliary obstruction caused by pancreatic carcinoma: a meta-analysis

INTRODUCTION: Between 42% and 77% of patients with distal malignant biliary obstruction (MBO) suffer from pancreatic carcinoma (PC). AIM: To analyse the clinical efficacy of stenting accompanied by high-intensity focused ultrasound (HIFU) ablation in patients with distal MBO from PC. MATERIAL AND METHODS: Relevant articles published through March 2021 were identified in the Pubmed, Cochrane Library, Embase, Wanfang, VIP, and CNKI databases. RevMan v5.3 and Stata v12.0 were used for the meta-analysis. RESULTS: Twenty-nine articles were initially identified, and 5 of these were eventually included. These articles described 142 patients who underwent biliary stenting alone and 132 patients who underwent biliary stenting with HIFU ablation. The pooled Δ total bilirubin (TBIL) values were comparable between the 2 treatment groups (p = 0.10). The pooled stent dysfunction rate was significantly greater in the group with stenting alone (p = 0.03), and the pooled HR for the stent patency duration indicated that the duration of stent patency was increased in the stenting with HIFU ablation group (p < 0.0001). Overall survival rates were significantly longer in the stenting with HIFU ablation group (p < 0.0001). HIFU ablation was associated with an 80% pooled clinical response rate. The pooled cholangitis (p = 0.47) and pancreatitis (p = 0.56) rates were comparable between the 2 groups. Funnel plots did not reveal any significant evidence of endpoint-associated publication bias. CONCLUSIONS: Stenting with HIFU ablation increased both stent patency and overall survival in patients with distal MBO caused by PC compared to stenting alone.