Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis

Abstract

BackgroundMalignant obstructive jaundice is a common problem in the clinic. Currently, the generally applied treatment methods are percutaneous transhepatic biliary drainage (PTBD) and endoscopic biliary drainage (EBD). Nevertheless, there has not been a uniform conclusion published on either efficacy of the two types of drainage or the incidence rate of complications. Therefore, we conducted a systematic review and meta-analysis of studies comparing endoscopic versus percutaneous biliary drainage in malignant obstructive jaundice, to determine whether there is any difference between percutaneous and endoscopic biliary drainage, with respect to efficacy and incidence rate of overall complications.MethodsThe enrolled studies contain a total of three randomized controlled trials and eleven retrospective studies, which together encompass 2246 patients with PTBD and 8100 patients with EBD.ResultsOur analysis indicates that there is no difference between PTBD and EBD with regard to therapeutic success rate (%), overall complication (%), intraperitoneal bile leak, 30-day mortality, sepsis, or duodenal perforation (%). Cholangitis and pancreatitis after PTBD were lower than after EBD, with odds ratios (OR) of 0.48 (95% confidence interval (CI), 0.31 to 0.74) and 0.16 (95% CI, 0.05 to 0.52), respectively. Incidences of bleeding and tube dislocation for PTBD were higher than EBD, OR of 1.81 (95% CI, 1.35 to 2.44) and 3.41 (95% CI, 1.10 to 10.60).ConclusionsThis meta-analysis indicates certain advantages for both PTBD and EBD. In the clinical practice, it is advised to choose specifically either PTBD or EBD, based on location of obstruction, purpose of drainage (as a preoperative procedure or a palliative treatment) and level of experience in biliary drainage at individual treatment centers.

Effect of preoperative biliary drainage in patients with moderately severe obstructive jaundice on the outcomes of pancreatoduodenectomy: A meta-analysis study

“…The decrease in bilirubin levels also helps the body overcome the surgical stress. 27 Although the total length of hospital stay of patients with PBD was slightly higher, when compared to non-PBD patients, the present study revealed that the postoperative hospital stay in the PBD group was significantly shorter than that in the non-PBD group. This observation was probably correlated to the decrease in postoperative complications and faster recovery.…”

Recommendations for Invasive Procedures in Patients With Diseases of the Liver and Biliary Tract: Report of a Joint Meeting of the Brazilian Society of Hepatology (Sbh), Brazilian Society of Digestive Endoscopy (Sobed) and Brazilian Society of Interventional Radiology and Endovascular Surgery (Sobrice)

“…There are metaanalyses showing positive results for PTBD as compared to ERCP for patients with malignant biliary obstruction. However, the results of these metaanalyses are limited due to significant heterogeneity across the studies and the limited data available specifically on the management of distal malignant biliary obstruction (117,118) . There fore, PTBD at this time could be considered as a suitable option to the endoscopic approach in cases of distal malignant tumors, particularly in selected centers with high expertise in percutaneous interventions.…”

Preoperative biliary drainage for pancreatic cancer

“…33 Nevertheless, there is still controversy in this area as a separate meta-analysis found no difference in technical success rates, leading some to argue that the evidence is quite heterogeneous. 34 When comparing the different types of endoscopic approaches, the use of EUS-BD has been reserved for patients that have failed ERCP. There are a variety of reasons to support this, including the novelty of EUS-BD, the lack of widespread availability and expertise, and until recently, the lack of high-quality evidence on its efficacy.…”