Endoscopic Retrograde Cholangiopancreaticography with or without Stenting in Patients with Pancreaticobiliary Malignancy: An Updated Meta-analysis

Endoscopic retrograde cholangiopancreaticography (ERCP) is a complex diagnostic and therapeutic approach that is used to identify and treat various hepatobiliary and pancreatic diseases [1]. About one third of the patients with pancreatico-biliary malignancy are amenable to surgical resection after detailed evaluation with trans-abdominal ultrasound, computerized tomographic scan, magnetic resonance cholangiopancreaticography (MRCP), and endoscopic retrograde cholangiopancreaticography (ERCP). Biliary obstruction is a frequent presenting feature of pancreaticobiliary malignancy [2]. Corrective surgery is the therapy of choice, but the majority of patients with pancreatico-biliary malignancy are incurable at the time of diagnosis due to local or distant metastases. Surgical treatment is found to be the best available option for patients diagnosed at a stage where the tumour is confined to the biliary tract. There are two ways to approach patients who are fit for surgical treatment: direct surgical approach or pre-surgical biliary decompression [3]. We have been unable to identify systematic reviews or meta-analyses of randomized clinical trials on the issue. We decided to explore the utility of preoperative endoscopic biliary drainage in patients with pancreatico-biliary stricture confirmed or suspected to be malignant, prior to surgery, by examining all randomized trials in a Cochrane systematic review [4]. We only included trials that compared ERCP with stenting versus ERCP without stenting. Clinical trials on non-endoscopic preoperative drainage will be considered in other systematic reviews.