Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice

• Published in: British journal of surgery 2013-11, Vol.100 (12), p.1589-1596
• Main Authors: Fang, Y., Gurusamy, K. S., Wang, Q., Davidson, B. R., Lin, H., Xie, X., Wang, C.
• Format: Article
• Language: English
• Subjects: Biliary Tract Surgical Procedures - methods; Biliary Tract Surgical Procedures - mortality; Drainage - methods; Drainage - mortality; Humans; Jaundice, Obstructive - mortality; Jaundice, Obstructive - surgery; Length of Stay; Patient Safety; Postoperative Complications - mortality; Postoperative Complications - prevention & control; Preoperative Care - methods; Preoperative Care - mortality; Quality of Life; Randomized Controlled Trials as Topic; Sphincterotomy, Endoscopic - methods; Sphincterotomy, Endoscopic - mortality; Treatment Outcome
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.9260

Background This meta‐analysis aimed to investigate whether preoperative biliary drainage (PBD) is beneficial to patients with obstructive jaundice. Methods Data from randomized clinical trials related to safety and effectiveness of PBD versus no PBD were extracted by two independent reviewers. Risk ratios, rate ratios or mean differences were calculated with 95 per cent confidence intervals (c.i.), based on intention‐to‐treat analysis, whenever possible. Results Six trials (four using percutaneous transhepatic biliary drainage and two using endoscopic sphincterotomy) including 520 patients with malignant or benign obstructive jaundice comparing PBD (265 patients) with no PBD (255) were included in this review. All trials had a high risk of bias. There was no significant difference in mortality (risk ratio 1.12, 95 per cent c.i. 0·73 to 1·71; P = 0·60) between the two groups. Overall serious morbidity (grade III or IV, Clavien–Dindo classification) was higher in the PBD group (599 complications per 1000 patients) than in the direct surgery group (361 complications per 1000 patients) (rate ratio 1·66, 95 per cent c.i. 1·28 to 2·16; P