EUS-Guided Vs. ERCP-Guided Biliary Drainage as Primary Approach to Malignant Distal Biliary Obstruction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

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, I2 = 61%), and for clinical success was 0.99 (95% CI = 0.95 - 1.04, p = 0.850, I2 = 0%). The pooled rate of procedure-related pancreatitis was 7.20% (95% CI = 3.60 - 13.80, I2 = 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, I2 = 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.

Informations de copyright

Copyright © 2024 by The American College of Gastroenterology.