Primary drainage of distal malignant biliary obstruction: A comparative network meta-analysis.

BACKGROUND

The effectiveness of various primary upfront drainage techniques for distal malignant biliary obstructions (dMBO) is not well-established.

OBJECTIVE

To compare the technical and clinical success rates and adverse event (AE) rates of various primary drainage techniques.

METHODS

We systematically reviewed RCTs comparing the technical and clinical success and AE rates of EUS-choledochoduodenostomy (CDS) with lumen-apposing metal stent (LAMS), EUS-CDS with self-expandable metal stents (SEMS), EUS-hepaticogastrostomy (HGS), ERCP, and PTBD performed upfront.

RESULTS

Six RCTs involving 583 patients were analyzed. EUS-CDS with LAMS showed significantly higher technical success compared to EUS-CDS with SEMS (RR 1.21, 95 % CI 1.07-1.37) and ERCP (RR 1.17, 95 % CI 1.07-1.28). EUS-CDS with LAMS had the highest rank in technical success (SUCRA = 0.86). The clinical success rate was also higher with EUS-CDS with LAMS than with ERCP (RR 1.12, 1.01-1.25). PTBD was the worst ranked procedure for safety (SUCRA score = 0.18), while EUS-CDS with LAMS was the top procedure for procedural time (SUCRA score = 0.83).

CONCLUSION

EUS-CDS with LAMS has the highest technical and clinical success rates and is significantly superior to ERCP as the upfront technique for dMBO treatment. PTBD should be abandoned as first-line treatment due to the poor safety profile.

Informations de copyright

Copyright © 2024 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest G.L., L.A., P.G.A., A.R., C.H., A.F. have no conflict of interest to report regarding the study