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Review
. 2023 Jul 13;4(1):e274.
doi: 10.1002/deo2.274. eCollection 2024 Apr.

Endoscopic ultrasound-guided hepaticogastrostomy versus choledochoduodenostomy for malignant biliary obstruction: A meta-analysis

Hirofumi Yamazaki  1 , Yasunobu Yamashita  1 , Toshio Shimokawa  2 , Kosuke Minaga  3 , Takeshi Ogura  4 , Masayuki Kitano  1
Affiliations
Review

Endoscopic ultrasound-guided hepaticogastrostomy versus choledochoduodenostomy for malignant biliary obstruction: A meta-analysis

Hirofumi Yamazaki et al. DEN Open. .

Abstract

Objectives: Endoscopic ultrasound (EUS)-guided biliary drainage encompasses techniques such as EUS-guided hepaticogastrostomy (EUS-HGS) and EUS-guided choledochoduodenostomy (EUS-CDS). This meta-analysis compared the efficacy of EUS-CDS with that of EUS-HGS for the treatment of biliary obstruction.

Methods: A systematic meta-analysis of all relevant articles listed was performed by searching the Cochrane Library, PubMed, and Google Scholar databases. We used random effects or fixed effects models to compare success rates, adverse events, procedure times, and time to recurrent biliary obstruction after EUS-CDS and EUS-HGS.

Results: This meta-analysis included 18 eligible studies. There was no significant difference between EUS-CDS and EUS-HGS with respect to technical success rate (odds ratio [OR] 1.04; 95% confidence interval [CI] 0.62-1.73) and clinical success rate (OR 0.66; 95% CI 0.43-1.04), or with respect to total procedure-related adverse events (OR 1.39; 95% CI 1.00-1.93). Subgroup analysis of adverse events revealed that the rate of recurrent biliary obstruction (RBO) was significantly higher for EUS-HGS (OR 2.95; 95% CI 1.54-5.64). There was no significant difference between the two methods with respect to time to recurrent biliary obstruction (mean difference -11.93 days; 95% CI -47.77-23.91). However, the procedure time was longer for EUS-HGS (mean difference, 3.21 min; 95% CI 1.24-5.19).

Conclusion: EUS-CDS and EUS-HGS are comparable in terms of technical success, clinical success, and rate of adverse events; however, EUS-CDS is superior with respect to procedure time and preventing RBO.

Keywords: EUS‐guided biliary drainage; biliary obstruction; choledochoduodenostomy; hepaticogastrostomy; meta‐analysis.

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Conflict of interest statement

Masayuki Kitano has received honoraria (for lectures) from Olympus, and research funding from Boston Scientific and Zeon Medical. Author Takeshi Ogura is an Associate Editor of DEN Open. The other authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Flowchart illustrating the study selection process for the meta‐analysis. EUS‐HGS, endoscopic ultrasound‐guided hepaticogastrostomy; EUS‐CDS, endoscopic ultrasound‐guided choledochoduodenostomy.
FIGURE 2
FIGURE 2
Quality assessment of studies according to QUADAS‐2. Gray = high risk of bias; Orange = unclear risk of bias; Blue = low risk of bias.
FIGURE 3
FIGURE 3
Forest plot comparing the technical success rates of EUS‐HGS and EUS‐CDS. OR, odds ratio; CI, confidence interval; EUS‐HGS, endoscopic ultrasound‐guided hepaticogastrostomy; EUS‐CDS, endoscopic ultrasound‐guided choledochoduodenostomy.
FIGURE 4
FIGURE 4
Forest plot comparing the clinical success rates of EUS‐HGS and EUS‐CDS. OR, odds ratio; CI, confidence interval; EUS‐HGS, endoscopic ultrasound‐guided hepaticogastrostomy; EUS‐CDS, endoscopic ultrasound‐guided choledochoduodenostomy.
FIGURE 5
FIGURE 5
Forest plot comparing adverse events after EUS‐HGS and EUS‐CDS. OR, odds ratio; CI, confidence interval; EUS‐HGS, endoscopic ultrasound‐guided hepaticogastrostomy; EUS‐CDS, endoscopic ultrasound‐guided choledochoduodenostomy.
FIGURE 6
FIGURE 6
Forest plot comparing recurrent biliary obstruction (RBO) after EUS‐HGS and EUS‐CDS. MD, mean difference; CI, confidence interval; EUS‐HGS, endoscopic ultrasound‐guided hepaticogastrostomy; EUS‐CDS, endoscopic ultrasound‐guided choledochoduodenostomy.
FIGURE 7
FIGURE 7
Forest plot comparing the procedure time of EUS‐HGS with that of EUS‐CDS. MD, mean difference; CI, confidence interval; EUS‐HGS, endoscopic ultrasound‐guided hepaticogastrostomy; EUS‐CDS, endoscopic ultrasound‐guided choledochoduodenostomy.
FIGURE 8
FIGURE 8
Forest plot comparing time to recurrent biliary obstruction after EUS‐HGS with that after EUS‐CDS. MD, mean difference; CI, confidence interval; EUS‐HGS, endoscopic ultrasound‐guided hepaticogastrostomy; EUS‐CDS, endoscopic ultrasound‐guided choledochoduodenostomy.
See this image and copyright information in PMC

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