Primary EUS-guided biliary drainage versus ERCP drainage for the management of malignant biliary obstruction: A systematic review and meta-analysis

Abstract

EUS-guided biliary drainage (EUS-BD) has been used as a salvage modality for relief of malignant biliary obstruction (MBO) after a failed ERCP. Multiple recent randomized controlled trials (RCTs) and observational studies have been published to assess the suitability of EUS-BD as a first-line modality for achieving palliative BD. We aimed to perform a systematic review and meta-analysis comparing primary EUS-BD versus ERCP for MBO. We searched PubMed, Medline, and Embase up to January 1, 2019, to identify RCTs and observational studies evaluating the efficacy and safety of primary EUS-BD (without a prior attempted ERCP) versus ERCP. Quality of RCTs and observational studies was assessed using Jadad and Newcastle–Ottawa scores, respectively. The outcomes of interest were technical success, clinical success, odds of requiring a repeat intervention, and procedure-related adverse events. Odds ratios (ORs) and standard mean difference were calculated for categorical and continuous variables, respectively. Meta-analysis was performed using the random effects model in RevMan 5.3 (the Cochrane Collaboration, the Nordic Cochrane Centre, Copenhagen, Denmark). Five studies (three RCTs and two observational studies) with 361 patients were included. Both procedures achieved comparable technical success (OR: 1.20 [0.44–3.24], I 2 = 0%) and clinical success (OR: 1.44, confidence interval [CI]: 0.63–3.29, I 2 = 0%). The overall adverse outcomes (OR: 1.59 [0.89–2.84]) did not differ between the two groups. In the ERCP group, 9.5% of patients developed procedure-related pancreatitis versus zero in the EUS group (risk difference = 0.08%, P = 0.02). There was no statistically significant difference in nonpancreatitis-related adverse events. The odds of requiring reintervention for BD (1.68 [0.76–3.73], I 2 = 42%) did not differ significantly. The ERCP group had significantly higher odds of requiring reintervention due to tumor overgrowth (5.35 [1.64–17.50], I 2 = 0%). EUS-BD has comparable technical and clinical success to ERCP and can potentially be used as a first-line palliative modality for MBO where expertise is available. ERCP-related pancreatitis which can cause significant morbidity can be completely avoided with EUS.

Society of Gastrointestinal Endoscopy of India Consensus Guidelines on Endoscopic Ultrasound-Guided Biliary Drainage: Part I (Indications, Outcomes, Comparative Evaluations, Training)

“…In a systematic review and meta-analysis of five studies, 361 patients (190 in the ERCP group and 171 in the EUS group), it was found that the technical and clinical success were comparable. 40 The overall adverse events were similar between the two groups. In the ERCP group, 9.5% of patients developed procedure-related pancreatitis while no patient developed pancreatitis in the EUS group (risk difference ¼ 0.08%, p ¼ 0.02).…”

Drenagem biliar endoscópica ecoguiada: revisão da literatura

“…Os autores concluíram que não existem evidências claras que sustentem a recomendação de preferência por uma das técnicas ou por um dos tipos de próteses. Em 2019 e 2020, foram publicadas três metanálises [33][34][35] que endossam que a DBE possui desempenho semelhante a CPER na desobstrução maligna da via biliar, com alívio da icterícia e oferecendo ainda a vantagem de risco nulo de pancreatite pós procedimento.…”

Experience-Related Factors in the Success of Beginner Endoscopic Ultrasound-Guided Biliary Drainage: A Multicenter Study

“…EUS-BD with transluminal stenting, including EUS-guided hepaticogastrostomy (EUS-HGS), choledochoduodenostomy (EUS-CDS), and antegrade biliary stenting (EUS-ABS), is recommended, especially in patients with malignant biliary obstructions; its effectiveness may be comparable with that of ERCP as the first-line management of certain biliary obstructions [ 7 , 8 , 9 , 10 , 11 ]. Since its first description in 2001 [ 12 ], the procedure has improved and shown high technical and clinical success rates of approximately 95% and 92–94%, respectively [ 3 , 10 ].…”