Endoscopic ultrasound‐guided versus endoscopic retrograde cholangiopancreatography‐guided biliary drainage for primary treatment of distal malignant biliary obstruction: A systematic review and meta‐analysis

Abstract

ObjectivesCurrent evidence supporting the utility of endoscopic ultrasound‐guided biliary drainage (EUS‐BD) as primary treatment for distal malignant biliary obstruction (MBO) is limited. We conducted a meta‐analysis to compare the performance of EUS‐BD and endoscopic retrograde cholangiopancreatography‐guided biliary drainage (ERCP‐BD) as primary palliation of distal MBO.MethodsWe searched several databases for comparative studies evaluating EUS‐BD vs. ERCP‐BD in primary drainage of distal MBO up to 28 February 2019. Primary outcomes were technical success and clinical success. Secondary outcomes included adverse events, stent patency, stent dysfunction, tumor in/overgrowth, reinterventions, procedure duration, and overall survival.ResultsFour studies involving 302 patients were qualified for the final analysis. There was no difference in technical success (risk ratio [RR] 1.00; 95% confidence interval [95% CI] 0.93–1.08), clinical success (RR 1.00; 95% CI 0.94–1.06) and total adverse events (RR 0.68; 95% CI: 0.31–1.48) between the two procedures. EUS‐BD was associated with lower rates of post‐procedure pancreatitis (RR 0.12; 95% CI 0.02–0.62), stent dysfunction (RR 0.54; 95% CI 0.32–0.91), and tumor in/overgrowth (RR 0.22; 95% CI 0.07–0.76). No differences were noted in reinterventions (RR 0.59; 95% CI 0.21–1.69), procedure duration (weighted mean difference −2.11; 95% CI −9.51 to 5.29), stent patency (hazard ratio [HR] 0.61; 95% CI 0.34–1.11), and overall survival (HR 1.00; 95% CI 0.66–1.51).ConclusionsWith adequate endoscopy expertise, EUS‐BD could show similar efficacy and safety when compared with ERCP‐BD for primary palliation of distal MBO and exhibits several clinical advantages.

Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

“…Several meta-analyses have shown endoscopic ultrasoundguided biliary drainage (EUS-BD) to be a safe and effective option after failed ERCP-guided biliary drainage [113][114][115]. Recently, the choice between EUS-BD versus ERCP-guided biliary drainage as the primary modality in malignant bile duct obstruction has been analyzed in eight meta-analyses [116][117][118][119][120][121][122][123]. Technical success (around 92 %-97 %) and clinical success (around 85 %-96 %) were high for both EUS-and ERCP-guided biliary drainage, and did not differ between approaches.…”

Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures

“…218 Two recent meta-analysis comparing EUSBD with ERCP-BD found that EUSBD has similar efficacy and safety as ERCP-BD in cases of distal malignant biliary obstruction. 219,220 An RCT studying 125 patients also confirmed that EUSBD and ERCPBD provide comparable technical and clinical success rates. 221 However, EUSBD was associated with longer stent patency, lower complications, and more preserved quality of life.…”

Tratamiento endoscópico de la obstrucción biliar en cáncer de páncreas no resecable

“…Finalmente, se ha propuesto el uso de DB-USE como tratamiento inicial de la obstrucción biliar distal maligna. Mientras que el éxito clínico y técnico al compararse con la CPRE son similares 16,17,19,[50][51][52][53] , el DB-USE parece estar asociado a menores eventos adversos 50 , particularmente el desarrollo de pancreatitis posprocedimiento 19,[51][52][53] , menor disfunción de la prótesis y necesidad de reintervención 51 . En el estudio de Tellez-Ávila FI., et al 18 , la DB-USE parece ser más costo efectiva comparada con la CPRE en pacientes con obstrucción biliar distal maligna 18 .…”