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To evaluate the efficacy of stent-in-stent (SIS) and side-by-side (SBS) bilateral stenting for treating malignant hilar biliary obstruction (MHBO). Relevant studies in Pubmed, Embase, and Cochrane Library were identified through June 2020. This meta-analysis was conducted using RevMan v5.3, using relevant endpoint data relating to clinical and technical success, complications, stent dysfunction, and overall survival (OS) rates extracted from these studies. We identified six relevant studies which included 315 MHBO patients treated with either SBS ( n  = 161) or SIS bilateral ( n  = 154) stenting. We saw no significant difference between these two groups with respect to clinical success (OR: 1.07; 95% CI: 0.46, 2.49,  p  = .87), complication (HR: 0.12; 95% CI: −0.04, 0.27,  p  = .15), stent dysfunction (OR: 0.68; 95% CI: 0.42, 1.10,  p  = .11), or OS (HR: 0.97; 95% CI: 0.82, 1.16,  p  = .74). However, the SBS group exhibited significantly lower technical success rates (OR: 6.55; 95% CI: 1.10, 38.83,  p  = .04). Significant heterogeneity was only detected for the endpoint of complication rates ( I 2= 60%). These results suggest that SIS bilateral stenting yields better rates of technical success than does SBS bilateral stenting in MHBO patients.

Bilateral stenting for hilar biliary obstruction: a meta-analysis of side-by-side versus stent-in-stent