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Review
. 2022 Jan-Feb;11(1):4-16.
doi: 10.4103/EUS-D-21-00009.

EUS-guided versus percutaneous transhepatic cholangiography biliary drainage for obstructed distal malignant biliary strictures in patients who have failed endoscopic retrograde cholangiopancreatography: A systematic review and meta-analysis

Umar Hayat  1 , Caitlin Bakker  2 , Ahmed Dirweesh  3 , Mohammed Y Khan  3 , Douglas G Adler  4 , Hayrettin Okut  1 , Noel Leul  2 , Mohammad Bilal  5 , Ali A Siddiqui  6
Affiliations
Review

EUS-guided versus percutaneous transhepatic cholangiography biliary drainage for obstructed distal malignant biliary strictures in patients who have failed endoscopic retrograde cholangiopancreatography: A systematic review and meta-analysis

Umar Hayat et al. Endosc Ultrasound. 2022 Jan-Feb.

Abstract

EUS-guided biliary drainage (EUS-BD) and percutaneous transhepatic cholangiography biliary drainage (PTC) are the two alternate methods for biliary decompression in cases where ERCP fails. We conducted a systematic review and meta-analysis of studies to compare the efficacy and safety of endoscopic and percutaneous biliary drainage for malignant biliary obstruction in patients with failed ERCP. A total of ten studies were included, fulfilling the inclusion criteria, including four retrospective studies and six randomized controlled trials. We compared the technical and clinical success rates and the acute, delayed, and total adverse events of EUS-BD with PTC. The odds ratios (ORs) and confidence intervals (CIs) were calculated. There was no difference between technical (OR: 0.47 [95% CI: 0.20-1.07]; P = 0.27) and clinical (OR: 2.24 [95% CI: 1.10-4.55]; P = 0.51) success rates between EUS-PD and PTC groups. Procedural adverse events (OR: 0.17 [95% CI: 0.09-0.31]; P = 0.03) and total adverse events (OR: 0.09 [95% CI: 0.02-0.38]; P < 0.01) were significantly different between the two groups; however, delayed adverse events were nonsignificantly different (OR: 0.73 [95% CI: 0.34-1.57]; P = 0.97). This meta-analysis indicates that endoscopic biliary drainage (EUS-BD) is equally effective but safer in terms of acute and total adverse events than percutaneous transhepatic biliary drainage (PTC) for biliary decompression in patients with malignant biliary strictures who have failed an ERCP.

Keywords: EUS-guided biliary drainage; confidence intervals; endoscopic retrograde cholangiopancreatography; malignant biliary strictures; malignant obstructive jaundice; meta-analysis; odds ratios; percutaneous transhepatic cholangiography.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Flowchart of the studies included
Figure 2
Figure 2
(a) Forest plot of the odds ratio of studies comparing the technical success rates of EUS-BD and PTC. (b) Forest plot of odds ratio of studies comparing the clinical success rates of EUS-BD and PTC. TE: Treatment effect; seTE: Standard error of treatment effect; OR: Odds ratio; CI: Confidence interval; PTC: Percutaneous transhepatic cholangiography; EUS-BD: EUS-biliary drainage
Figure 3
Figure 3
(a) Forest plot of the odds ratio of studies comparing the acute adverse event of EUS-BD and PTC. (b) Forest plot of odds ratio of studies comparing the chronic or delayed adverse event of EUS-BD and PTC. (c) Forest plot of odds ratio of studies comparing the total adverse events of EUS-BD and PTC. TE: Treatment effect; seTE: Standard error of treatment effect; OR: Odds ratio; CI: Confidence interval; PTC: Percutaneous transhepatic cholangiography; EUS-BD: EUS-biliary drainage
See this image and copyright information in PMC

References

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