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EUS-guided biliary drainage: A systematic review and meta-analysis.

ABSTRACT: ERCP is the current procedure of choice for patients with jaundice caused by biliary obstruction. EUS-guided biliary drainage (EUS-BD) has emerged as an alternative to ERCP in patients requiring biliary drainage. The aim of the study was to conduct a systematic review and meta-analysis to report the overall efficacy and safety of EUS-BD. We conducted a comprehensive search of several databases including PubMed, EMBASE, Web of Science, Google Scholar, and LILACS databases (earliest inception to June 2018) to identify studies that reported EUS-BD in patients. The primary outcome was to look at the technical and clinical success of the procedure. The secondary analysis focused on calculating the pooled rate of re-interventions and all adverse-events, along with the commonly reported adverse-event subtypes. Twenty-three studies reporting on 1437 patients were identified undergoing 1444 procedures. Majority of the patient population were male (53.86%), with an average age of 67.22 years. The pooled technical success rates and clinical success rates were 91.5% (95% confidence interval [CI]: 87.7-94.2, I[2] = 76.5) and 87% (95% CI: 82.3-90.6, I[2] = 72.4), respectively. The total adverse event rates were 17.9% (95% CI: 14.3-22.2, I[2] = 69.1). Subgroup analysis of three major individual adverse events was bile leak: 4.1% (2.7-6.2, I[2] = 46.7), stent migration: 3.9% (2.5-6.2, I[2] = 43.5), and infection: 3.8% (2.8-5.1, I[2] = 0) Substantial heterogeneity was noted in the analysis. EUS-BD has high technical and clinical success rate and hence a very effective procedure. Concerns about publication bias exist. Careful consideration should be given to the adverse events and weighing the risks and benefits of the alternative nonsurgical/surgical approaches.

SUBMITTER: Dhindsa BS

PROVIDER: S-EPMC7279084 | biostudies-literature | 2020 Mar-Apr

REPOSITORIES: biostudies-literature

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EUS-guided biliary drainage: A systematic review and meta-analysis.

Dhindsa Banreet Singh BS Mashiana Harmeet Singh HS Dhaliwal Amaninder A Mohan Babu P BP Jayaraj Mahendran M Sayles Harlan H Singh Shailender S Ohning Gordon G Bhat Ishfaq I Adler Douglas G DG

Endoscopic ultrasound 20200301 2

ERCP is the current procedure of choice for patients with jaundice caused by biliary obstruction. EUS-guided biliary drainage (EUS-BD) has emerged as an alternative to ERCP in patients requiring biliary drainage. The aim of the study was to conduct a systematic review and meta-analysis to report the overall efficacy and safety of EUS-BD. We conducted a comprehensive search of several databases including PubMed, EMBASE, Web of Science, Google Scholar, and LILACS databases (earliest inception to J ...[more]

PMID: 32295967

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Project description:The operative treatment combined with preoperative biliary drainage (PBD) has been established as a safe Klatskin tumor (KT) treatment strategy. However, there has always been a dispute for the preferred technique for PBD technique. This meta-analysis was conducted to compare the biliary drainage-related cholangitis, pancreatitis, hemorrhage, and the success rates of palliative relief of cholestasis between percutaneous transhepatic biliary drainage (PTBD) and endoscopic biliary drainage (EBD), to identify the best technique in the management of KT.PubMed, EMBASE, and Web of Science were searched systematically for prospective or retrospective studies reporting the biliary drainage-related cholangitis, pancreatitis, hemorrhage, and the success rates of palliative relief of cholestasis in patients with KT. A meta-analysis was performed, using the fixed or random-effect model, with Review Manager 5.3.PTBD was associated with lower risk of cholangitis (risk ratio [RR]?=?0.49, 95% confidence interval [CI]: 0.36-0.67; P?<?.00001), particularly in patients with Bismuth-Corlette type II, III, IV KT (RR?=?0.50, 95% CI: 0.33-0.77; P?=?.05). Compared with EBD, PTBD was also associated with a lower risk of pancreatitis (RR?=?0.35, 95% CI: 0.17-0.69; P?=?0.003) and with higher successful rates of palliative relief of cholestasis (RR?=?1.20, 95% CI: 1.10-1.31; P?<?.0001). The incidence of hemorrhage was similar in these 2 groups (RR 1.29, 95% CI: 0.51-3.27; P?=?.59). The risk of biliary drainage-related cholangitis (RR?=?1.96, 95% CI: 0.96-4.01; P?=?.06) and pancreatitis (RR?=?1.62, 95% CI: 0.76-3.47; P?=?.21) was similar between endoscopic nasobiliary drainage groups and biliary stenting.In patients with type II or type III or IV KT who need to have PBD, PTBD should be performed as an initial method of biliary drainage in terms of reducing the incidence of procedure related cholangitis, pancreatitis, and improving the rates of palliative relief of cholestasis. Well-conducted randomized controlled trials with a universial criterion for PBD are required to confirm these findings.

Dataset Information

EUS-guided biliary drainage: A systematic review and meta-analysis.

Publications

EUS-guided biliary drainage: A systematic review and meta-analysis.

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