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Review
. 2019 Sep-Oct;8(5):310-317.
doi: 10.4103/eus.eus_24_19.

The incremental benefit of EUS for the identification of malignancy in indeterminate extrahepatic biliary strictures: A systematic review and meta-analysis

Albert Chiang  1 , Martin Theriault  2 , Misbah Salim  3 , Paul Damien James  3
Affiliations
Review

The incremental benefit of EUS for the identification of malignancy in indeterminate extrahepatic biliary strictures: A systematic review and meta-analysis

Albert Chiang et al. Endosc Ultrasound. 2019 Sep-Oct.

Abstract

This systematic review aims to assess the literature to determine the impact of EUS for diagnosing malignancy among indeterminate extrahepatic biliary strictures. A systematic review was performed using MEDLINE, EMBASE, Cochrane, and conference proceedings from inception to July 2016. Pooled results were calculated using random-effects model, and heterogeneity was explored using stratified meta-analysis and meta-regression. The main outcome was the incremental benefit of EUS (IBEUS) for the diagnosis of malignancy among patients who have undergone ERCP with brushing cytology for extrahepatic biliary strictures. Of 3131 identified citations, ten met the inclusion criteria and were included in the final analyses (study periods from 1998 to 2014). Pooled IBEUS estimate with the adjustment for publication bias was 14% (95% confidence interval, 7%-20%). Individual studies demonstrate that the IBEUS is greater for distal biliary strictures or when an extrinsic mass is identified on cross-sectional imaging. EUS increases the identification of malignancy for indeterminate biliary strictures following a nondiagnostic ERCP, particularly those that are distal or related to extrinsic compression.

Keywords: Diagnosis; ERCP; EUS; EUS-FNA; biliary stricture; incremental benefit; malignancy.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Flowchart illustration of study selection for meta-analysis
Figure 2
Figure 2
Forest plot of pooled estimate of effect for the incremental benefit of EUS in identifying malignancy after nondiagnostic ERCP. CI: Confidence interval; IBEUS: Incremental benefit of EUS
Figure 3
Figure 3
Funnel plot for studies considering the incremental benefit of EUS in identifying malignancy after nondiagnostic ERCP
Figure 4
Figure 4
Proposed diagnostic algorithm for the assessment of indeterminate biliary strictures. CT: Computed tomography; MRI: Magnetic resonance imaging
See this image and copyright information in PMC

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References

    1. Brandi G, Venturi M, Pantaleo MA, et al. Cholangiocarcinoma: Current opinion on clinical practice diagnostic and therapeutic algorithms: A review of the literature and a long-standing experience of a referral center. Dig Liver Dis. 2016;48:231–41. - PubMed
    1. Navaneethan U, Njei B, Lourdusamy V, et al. Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: A systematic review and meta-analysis. Gastrointest Endosc. 2015;81:168–76. - PMC - PubMed
    1. Sadeghi A, Mohamadnejad M, Islami F, et al. Diagnostic yield of EUS-guided FNA for malignant biliary stricture: A systematic review and meta-analysis. Gastrointest Endosc. 2016;83:290–80. - PubMed
    1. Eloubeidi MA, Chen VK, Jhala NC, et al. Endoscopic ultrasound-guided fine needle aspiration biopsy of suspected cholangiocarcinoma. Clin Gastroenterol Hepatol. 2004;2:209–13. - PubMed
    1. Fritscher-Ravens A, Broering DC, Knoefel WT, et al. EUS-guided fine-needle aspiration of suspected hilar cholangiocarcinoma in potentially operable patients with negative brush cytology. Am J Gastroenterol. 2004;99:45–51. - PubMed