Preoperative biliary drainage for patients with malignant obstructive jaundice: an update on the systematic review and model-based Bayesian network meta-analysis

Background: Several procedures are available for preoperative biliary drainage, but the necessity and best clinical choice remain uncertain. The purpose was to compare the efficacy and safety of seven methods of preoperative biliary drainage with different surgical procedures, materials, or places of stents in patients with malignant obstructive jaundice. Methods: This study included randomized controlled trials, prospective and retrospective trials, and case-control studies focusing on preoperative biliary drainage (PBD). Meta-analysis and Bayesian Model-Based Network Meta-Analysis were used for data synthesis. The results were reported as odds ratios with 95% confidence intervals for binary outcomes and mean differences or standardized mean differences with 95% confidence intervals for continuous outcomes. Results: This study included 81 articles involving 26 251 patients. Fully covered self-expandable metal stents with endoscopic retrograde cholangiopancreatography have the fewest adverse events compared with plastic stents (OR = 0.16, 95% CI = 0.05 to 0.41, moderate certainty) and other procedures, yet associated with the highest incidence of pancreatitis. Plastic stent was associated with increased complications and shorter duration. Internal stent is the best for patients with perihilar obstruction. Conclusions: This study suggests that preoperative biliary drainage exerts significant variation in clinical efficacy and safety across different procedures. Fully covered self-expandable metal stents was the most recommended, while plastic stent is not recommended. Endoscopic retrograde cholangiopancreatography is the preferred procedure for preoperative biliary drainage, with percutaneous biliary drainage serving as a viable alternative. Internal stent is the most recommended for patients with perihilar obstruction.