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. 2025 Jul;58(4):533-543.
doi: 10.5946/ce.2024.183. Epub 2025 Feb 24.

Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials

Yousaf Zafar  1 , Hafsa Azam  2 , Muhammad Abdullah Bin Azhar  2 , Fabeeha Shaheen  2 , Syed Sarmad Javaid  2 , Laila Manzoor  1 , Muaaz Masood  3 , Rajesh Krishnamoorthi  3
Affiliations

Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials

Yousaf Zafar et al. Clin Endosc. 2025 Jul.

Abstract

Background: Malignant biliary obstruction is a major clinical challenge. We assessed the efficacy of endoscopic ultrasound-guided biliary drainage (EUS-BD) compared with that of endoscopic retrograde cholangiopancreatography biliary drainage (ERCP-BD) or percutaneous transhepatic biliary drainage (PTBD).

Methods: We searched for randomized controlled trials comparing EUS-BD with ERCP or PTBD in treating malignant biliary obstruction. Using random-effects models, we synthesized risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs). A subgroup analysis was performed using a comparator (ERCP or PTBD).

Results: EUS-BD significantly reduced the risk of stent dysfunction (RR, 0.46; 95% CI, 0.33-0.64), with consistent results in subgroup analysis for ERCP (RR, 0.54; 95% CI, 0.35-0.84) and PTBD (RR, 0.37; 95% CI, 0.22-0.61). It also lowered the risk of post-procedure pancreatitis (RR, 0.24; 95% CI, 0.07-0.83) and reduced tumor ingrowth or overgrowth risk (RR, 0.27; 95% CI, 0.11-0.65), even when compared to ERCP alone (RR, 0.28; 95% CI, 0.11-0.70). EUS-BD demonstrated a lower risk of adverse events compared to PTBD (RR, 0.37; 95% CI, 0.14-0.97) and reduced length of hospital stay (WMD, -1.03; 95% CI, -1.53 to -0.53) when compared to ERCP.

Conclusions: EUS-BD outperformed ERCP-BD and PTBD in reducing stent dysfunction, postprocedural pancreatitis, and tumor ingrowth or overgrowth.

Keywords: Biliary tract diseases; Endoscopic retrograde cholangiopancreatography; Endoscopy; Meta-analysis.

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Conflict of interest statement

Conflicts of Interest

The authors have no potential conflicts of interest.

Figures

Fig. 1.
Fig. 1.
A PRISMA flow diagram showing the search strategy for the meta-analysis.
Fig. 2.
Fig. 2.
Stent dysfunction requiring biliary re-intervention in EUS-BD vs. ERCP-BD/PTBD. Forest plot showing pooled rates of stent dysfunction requiring biliary re-intervention. EUS-BD, endoscopic ultrasound-guided biliary drainage; ERCP-BD, endoscopic retrograde cholangiopancreatography biliary drainage; PTBD, percutaneous transhepatic biliary drainage; M-H, Mantel-Haenszel; CI, confidence interval.
Fig. 3.
Fig. 3.
Post-procedure pancreatitis in EUS-BD vs. ERCP-BD/PTBD. Forest plot showing pooled rates of post-procedure pancreatitis. EUS-BD, endoscopic ultrasound-guided biliary drainage; ERCP-BD, endoscopic retrograde cholangiopancreatography biliary drainage; PTBD, percutaneous transhepatic biliary drainage; M-H, Mantel-Haenszel; CI, confidence interval.
Fig. 4.
Fig. 4.
Tumor ingrowth or overgrowth in EUS-BD vs. ERCP-BD/PTBD. Forest plot showing pooled rates of tumor ingrowth or overgrowth. EUS-BD, endoscopic ultrasound-guided biliary drainage; ERCP-BD, endoscopic retrograde cholangiopancreatography; PTBD, percutaneous transhepatic biliary drainage; M-H, Mantel-Haenszel; CI, confidence interval.
Fig. 5.
Fig. 5.
Length of hospital stay EUS-BD vs. ERCP-BD. Forest plot showing pooled results of length of hospital stay. EUS-BD, endoscopic ultrasound-guided biliary drainage; ERCP-BD, endoscopic retrograde cholangiopancreatography biliary drainage; SD, standard deviation; IV, inverse-variance; CI, confidence interval.
None
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