Choledochoduodenostomy Versus Hepaticogastrostomy in Endoscopic Ultrasound-guided Drainage for Malignant Biliary Obstruction: A Meta-analysis and Systematic Review

Abstract

Objectives: This study aimed to estimate the safety and efficacy of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) for malignant biliary obstruction. Methods: We conducted a literature search using PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Studies that compared EUS-CDS and EUS-HGS were included in this study. Results: Thirteen studies were eligible for inclusion. The technical [odds ratio (OR): 0.95; 95% confidence interval (CI): 0.51-1.74) and clinical (OR: 1.13; 95%CI: 0.66-1.94) success rates of EUS-CDS were comparable to those of EUS-HGS. However, EUS-CDS had less reintervention (OR: 0.31; 95%CI: 0.16-0.63) and stent obstruction (OR: 0.48; 95%CI: 0.21-0.94) than EUS-HGS. Both groups had similar adverse events (OR: 1.00; 95%CI: 0.70-1.43) and overall survival (hazard ratio: 1.07; 95%CI: 0.58-1.97). Conclusions: EUS-CDS and EUS-HGS have comparable technical and clinical success rates, adverse events, and overall survival. However, EUS-CDS has less reintervention and stent obstruction.

Methods for Drainage of Distal Malignant Biliary Obstruction after ERCP Failure: A Systematic Review and Network Meta-Analysis

“…Secondly, the comparison between EUS-HG and EUS-CD was not significant in any of the outcomes assessed, thus confirming the results of a previous meta-analysis [7]. However, as commented above, our results will likely need to be updated, considering the increasing evidence on the use of LAMS for EUS-CD [26], as well the widespread use of new dedicated stents for EUS-HGS [28].…”

“…Previous meta-analyses showed that EUS-BD was associated with better clinical success and fewer post-procedure complications than PTBD [8]. Another report indicated comparable performance rates between EUS-CD and EUS-HG [7]. However, an overall comparative assessment among the different interventions for DMBO after ERCP failure is still lacking.…”

“…However, an overall comparative assessment among the different interventions for DMBO after ERCP failure is still lacking. Moreover, previous meta-analyses [5,[7][8][9][10][11] included both RCTs and retrospective studies, hence the pressing need of a network meta-analysis based on the combination of direct and indirect evidence to gather comparative data to inform clinical guidelines. Therefore, through a network meta-analysis of five RCTs, we made several key observations.…”

“…Of these techniques, EUS-CD and EUS-HG are the two main approaches used in biliary drainage. Several studies and met a-analysis has been published over the years comparing both techniques, showing comparable outcomes with respect to clinical and technical success rates, as well as adverse outcomes and mortality [5,[7][8][9][10].…”

Endoscopic ultrasound-guided biliary drainage and gastrointestinal anastomoses: the journey from promising innovations to standard of care

“…The most recent meta-analysis comparing EUS-HGS and EUS-CDS included 13 studies (1 RCT, 3 prospective and 9 retrospective studies) for a total of 759 patients (359 EUS-CDS and 400 EUS-HGS patients) and suggested that the 2 approaches have similar technical/clinical success rates and safety, but with less stent obstruction and need for reintervention in favor of EUS-CDS (OR 0.33, 95%CI 0.15-0.70; I 2 =0%). This difference, however, was not confirmed in a sub-analysis that included only fully covered SEMS, while no specific analyses regarding LAMS are available [ 43 ].…”