Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Mar-Apr;9(2):101-109.
doi: 10.4103/eus.eus_80_19.

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

Banreet Singh Dhindsa  1 , Harmeet Singh Mashiana  2 , Amaninder Dhaliwal  2 , Babu P Mohan  3 , Mahendran Jayaraj  4 , Harlan Sayles  5 , Shailender Singh  2 , Gordon Ohning  4 , Ishfaq Bhat  2 , Douglas G Adler  6
Affiliations
Review

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

Banreet Singh Dhindsa et al. Endosc Ultrasound. 2020 Mar-Apr.

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.

Keywords: Biliary drainage; Biliary obstruction; ERCP; EUS guided; jaundice.

PubMed Disclaimer

Conflict of interest statement

None

Figures

Figure 1
Figure 1
Forest plot – Technical success
Figure 2
Figure 2
Forest plot – Clinical success
Figure 3
Figure 3
Forest plot – Reintervention
Figure 4
Figure 4
Forest plot – All adverse events
See this image and copyright information in PMC

References

    1. Enochsson L, Swahn F, Arnelo U, et al. Nationwide, population-based data from 11,074 ERCP procedures from the Swedish registry for gallstone surgery and ERCP. Gastrointest Endosc. 2010;72:1175–84. 1184e1-3. - PubMed
    1. Giovannini M, Moutardier V, Pesenti C, et al. Endoscopic ultrasound-guided bilioduodenal anastomosis: A new technique for biliary drainage. Endoscopy. 2001;33:898–900. - PubMed
    1. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5. - PubMed
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88. - PubMed
    1. Sutton AJ, Abrams KR, Jones DR, et al. Methods for Meta-Analysis in Medical Research. New York: John Wiley and Sons Ltd; 2000. pp. 205–8.