Endoscopic Ultrasound–Guided vs Endoscopic Retrograde Cholangiopancreatography–Guided Biliary Drainage as Primary Approach to Malignant Distal Biliary Obstruction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background and Study Aims Endoscopic ultrasound-guided biliary drainage (EUS-BD) is an alternative to endoscopic retrograde cholangiopancreatography (ERCP) guided transpapillary drainage in malignant distal biliary obstruction (MDBO). This meta-analysis of randomized controlled trials (RCTs) aims to compare the outcomes of these two approaches. Methods Electronic databases from January 2005 through December 2023 were searched for RCTs comparing outcomes of EUS-BD and ERCP for treating MDBO. Pooled proportions, risk ratio, and odds ratio were calculated using random-effects models. Results Five RCTs comprising 519 patients were included in the final analysis. The pooled risk ratio (RR) for overall technical success with EUS-BD compared to ERCP was 1.05 (95% CI = 0.96 - 1.16, p = 0.246, I 2 = 61%), and for clinical success was 0.99 (95% CI = 0.95 - 1.04, p = 0.850, I 2 = 0%). The pooled rate of procedure-related pancreatitis was 7.20% (95% CI = 3.60 - 13.80, I 2 = 34%) in the ERCP group compared to zero in the EUS-BD group. The pooled RR for stent dysfunction with EUS-BD compared to ERCP was 0.48 (95% CI = 0.28 - 0.83, p = 0.008, I 2 = 7%). The weighted mean procedure time was 13.43 (SD = 10.12) minutes for EUS- BD compared to 21.06 (SD = 6.64) minutes for ERCP. The mean stent patency was 194.11 (SD = 52.12) days in the EUS-BD group and 187 (SD = 60.70) days in the ERCP group. Conclusions EUS-BD is an efficient and safe alternative to ERCP in MDBO. An almost nonexistent risk of procedure-related pancreatitis, lower procedure time, and ease of use makes this an attractive primary approach to biliary decompression in centers with expertise.

A case report of definitive endoscopic management of a large right liver lobe hydatid cyst - A novel approach

“…These interventions chiefly refer to the management of pancreatic fluid collections within the pancreatitis etiology as well as the drainage of the biliary system in advanced malignancies and inaccessible anatomy [ 17 ]. In one of the most recent systematic review and meta-analysis about EUS guided vs ERCP guided biliary drainage, the authors concluded that in malignant distal biliary obstruction, using EUS guided biliary drainage is associated with an almost non-existent risk of procedure related pancreatitis, a lower procedure time and increased ease of use in centers with expertise [ 18 ].…”

Dedicated Echoendoscope for Interventional Endoscopic Ultrasound: Comparison with a Conventional Echoendoscope

“…Procedures that involve endoscopic ultrasound (EUS) are frequently performed worldwide [1][2][3]. Diagnostic EUS and EUS-guided fine needle aspiration are basic procedures at academic and referral centers, while an interventional EUS (I-EUS) is technically difficult and has a risk of serious adverse events [4,5].…”