TPTH 9.08 Scalpel vs. Scope: Surgical Drainage Outperforms Endoscopic Stenting (A Systematic Review and Meta-analysis)

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ID: 324035
2026
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Abstract
Abstract Background Preoperative biliary drainage (PBD) is standard for obstructive jaundice in periampullary cancer, yet the optimal method remains debated. While endoscopic stenting (ES) is widely utilised, it is linked to bacterial colonisation and infectious complications. Few studies compare ES with surgical drainage (SD). This study aims to compare clinical outcomes of ES versus SD in patients undergoing curative resection. Methods Standard medical databases MEDLINE, Embase, PubMed and Cochrane Library were searched for studies comparing ES versus SD. Statistical analysis was performed using Review Manager Software 5.4, and the meta-analysis was performed with the random effects model analysis to calculate Odds Ratios (OR) with 95% Confidence Intervals (CI). Results The search yielded 30 papers, of which only 2 met the strict inclusion criteria. Analysis of the pooled cohort (n=544) revealed distinct advantages for the surgical approach. The ES group had significantly higher odds of post-procedural pancreatitis (OR 5.65; 95% CI [1.56, 20.49]; z=2.63, p=0.008) and cholangitis (OR 7.98; 95% CI [1.06, 60.31]; z=2.01, p=0.04). Regarding postoperative outcomes, ES demonstrated significantly higher odds of intra-abdominal abscess (OR 3.95; 95% CI [1.16, 13.44]; z=2.20, p=0.03). No significant difference was found for postoperative pancreatic fistula (OR 2.12; 95% CI [0.75, 5.98]; z=1.41, p=0.16) or reoperation (z=0.80, p=0.42). Conclusions Surgical drainage appears superior to endoscopic stenting regarding specific infective and procedural complications. ES is associated with significantly increased risks of pancreatitis, cholangitis, and intra-abdominal abscess. Given the paucity of data in this area, these findings warrant a rethink of current treatment.
Reference Key
openalex_W7172533125 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Abir Mamun, Yahya El-Tahlawy, Yumna Saleem, Omar Lubbad
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.523
URL
https://doi.org/10.1093/bjs/znag087.523
Keywords Keywords not found

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