3 Committee considerations

3 Committee considerations

The evidence

3.1 To inform the committee, NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 9 sources, which was discussed by the committee. The evidence included 1 randomised controlled trial, 1 systematic review, 4 non-randomised comparative studies (3 of which are also included in the systematic review), and 3 case series (2 of which are also included in the systematic review), and is presented in table 2 of the interventional procedures overview. Other relevant literature is in the appendix of the overview.

3.2 The specialist advisers and the committee considered the key efficacy outcomes to be: improved quality of life, relief of jaundice, relief of biliary obstruction, reduced stricture and improved survival.

3.3 The specialist advisers and the committee considered the key safety outcomes to be: bleeding, liver infarction, infection, pancreatitis, cholangitis and biliary leakage.

3.4 Patient commentary was sought but none was received.

Committee comments

3.5 Most of the studies described the use of this procedure to treat a stricture followed by stent insertion, but this procedure may also have a role in unblocking existing stents.

ISBN: 978-1-4731-2950-4