Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis

doi:10.1016/j.gie.2016.12.023

Gastrointestinal Endoscopy

Volume 85, Issue 5, May 2017, Pages 904-914

https://doi.org/10.1016/j.gie.2016.12.023 Get rights and content

Background and Aims

EUS-guided biliary drainage (EUS-BD) is increasingly used as an alternate therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction in patients who fail ERCP. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures.

Methods

We searched several databases from inception to September 4, 2016 to identify comparative studies evaluating the efficacy and safety of EUS-BD and PTBD. Primary outcomes of interest were the differences in technical success and postprocedure adverse events. Secondary outcomes of interest included clinical success, rate of reintervention, length of hospital stay, and cost comparison for these 2 procedures. Odds ratios (ORs) and standard mean difference were calculated for categorical and continuous variables, respectively. These were analyzed using random effects model of meta-analysis.

Results

Nine studies with 483 patients were included in the final analysis. There was no difference in technical success between 2 procedures (OR, 1.78; 95% CI, .69-4.59; I² = 22%) but EUS-BD was associated with better clinical success (OR, .45; 95% CI, .23-.89; I² = 0%), fewer postprocedure adverse events (OR, .23; 95% CI, .12-.47; I² = 57%), and lower rate of reintervention (OR, .13; 95% CI, .07-.24; I² = 0%). There was no difference in length of hospital stay after the procedures, with a pooled standard mean difference of –.48 (95% CI, –1.13 to .16), but EUS-BD was more cost-effective, with a pooled standard mean difference of –.63 (95% CI, –1.06 to –.20). However, the latter 2 analyses were limited by considerable heterogeneity.

Conclusions

When ERCP fails to achieve biliary drainage, EUS-guided interventions may be preferred over PTBD if adequate advanced endoscopy expertise and logistics are available. EUS-BD is associated with significantly better clinical success, lower rate of postprocedure adverse events, and fewer reinterventions.

Graphical Abstract

Section snippets

Methods

We followed the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses¹² and Meta-Analysis of Observational Studies in Epidemiology¹³ to conduct this systematic review and meta-analysis.

Search strategy yield and quality assessment

The search strategy identified 421 studies, of which 189 were removed as duplicates and a further 160 were excluded as being ineligible based on title and abstract review. Manual search through the bibliographies of 72 eligible articles did not reveal additional studies. After full text review of these 72 articles, 63 were removed. The remaining 9 studies20, 21, 22, 23, 24, 25, 26, 27, 28 were included in the final analysis. Of these, 3 were RCTs20, 24, 28 and 6 were retrospective studies.21, 22

Discussion

This meta-analysis favors EUS-BD in comparison with PTBD for achieving satisfactory biliary drainage in patients who cannot be managed by ERCP. Although there was no difference in technical success of these 2 procedures, EUS-BD was associated with better clinical success, fewer postprocedure adverse events, and fewer reinterventions when compared with PTBD. However, on subgroup analysis, clinical success was similar for both procedures when data were derived from RCTs, whereas clinical success

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This document is a summary of the French intergroup guidelines of the management of biliary tract cancers (BTC) (intrahepatic, perihilar and distal cholangiocarcinomas, and gallbladder carcinomas) published in September 2023, available on the website of the French Society of Gastroenterology (SNFGE) (www.tncd.org).
This collaborative work was conducted under the auspices of French medical and surgical societies involved in the management of BTC. Recommendations were graded in three categories (A, B and C) according to the level of scientific evidence until August 2023.
BTC diagnosis and staging is mainly based on enhanced computed tomography, magnetic resonance imaging and (endoscopic) ultrasound-guided biopsy. Treatment strategy depends on BTC subtype and disease stage. Surgery followed by adjuvant capecitabine is recommended for localised disease. No neoadjuvant treatment is validated to date. Cisplatin-gemcitabine chemotherapy combined to the anti-PD-L1 inhibitor durvalumab is the first-line standard of care for advanced disease. Early systematic tumour molecular profiling is recommended to screen for actionable alterations (IDH1 mutations, FGFR2 rearrangements, HER2 amplification, BRAF^V600E mutation, MSI/dMMR status, etc.) and guide subsequent lines of treatment. In the absence of actionable alterations, FOLFOX chemotherapy is the only second-line standard-of-care. No third-line chemotherapy standard is validated to date.
These guidelines are intended to provide a personalised therapeutic strategy for daily clinical practice. Each individual BTC case should be discussed by a multidisciplinary team.
Therapeutic endoscopy: Recent updates and future directions
2024, Digestive and Liver Disease
The landscape of therapeutic endoscopy has undergone a remarkable evolution over the past few decades, carving out a niche that merges innovative technology with advanced clinical practice. As we venture further into the 21st century, the horizon of this field continues to expand, driven by rapid advancements in technology and a deeper understanding of gastrointestinal pathology. This review article aims to shed light on the recent advances and future trajectories of therapeutic endoscopy, focusing on pivotal areas such as third space endoscopy, endoscopic resection techniques, artificial endoscopy, endoscopic ultrasound (EUS), the integration of artificial intelligence (AI), and endoscopic anti-reflux therapies.
Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD)
2024, Gastrointestinal Endoscopy Clinics of North America
Endoscopic Management of Malignant Biliary Obstruction
2024, Gastrointestinal Endoscopy Clinics of North America
Adverse events with EUS-guided biliary drainage: a systematic review and meta-analysis
2023, Gastrointestinal Endoscopy
Multiple meta-analyses have evaluated the technical and clinical success of EUS-guided biliary drainage (BD), but meta-analyses concerning adverse events (AEs) are limited. The present meta-analysis analyzed AEs associated with various types of EUS-BD.
A literature search of MEDLINE, Embase, and Scopus was conducted from 2005 to September 2022 for studies analyzing the outcome of EUS-BD. The primary outcomes were incidence of overall AEs, major AEs, procedure-related mortality, and reintervention. The event rates were pooled using a random-effects model.
One hundred fifty-five studies (7887 patients) were included in the final analysis. The pooled clinical success rates and incidence of AEs with EUS-BD were 95% (95% confidence interval [CI], 94.1-95.9) and 13.7% (95% CI, 12.3-15.0), respectively. Among early AEs, bile leak was the most common followed by cholangitis with pooled incidences of 2.2% (95% CI, 1.8-2.7) and 1.0% (95% CI, .8-1.3), respectively. The pooled incidences of major AEs and procedure-related mortality with EUS-BD were .6% (95% CI, .3-.9) and .1% (95% CI, .0-.4), respectively. The pooled incidences of delayed migration and stent occlusion were 1.7% (95% CI, 1.1-2.3) and 11.0% (95% CI, 9.3-12.8), respectively. The pooled event rate for reintervention (for stent migration or occlusion) after EUS-BD was 16.2% (95% CI, 14.0-18.3; I² = 77.5%).
Despite a high clinical success rate, EUS-BD may be associated with AEs in one-seventh of the cases. However, major AEs and mortality incidence remain less than 1%, which is reassuring.
EUS-Guided Choledocho-duodenostomy Using Lumen Apposing Stent Versus ERCP With Covered Metallic Stents in Patients With Unresectable Malignant Distal Biliary Obstruction: A Multicenter Randomized Controlled Trial (DRA-MBO Trial)
2023, Gastroenterology
Several studies have compared primary endoscopic ultrasound (EUS)-guided biliary drainage to endoscopic retrograde cholangiopancreatography (ERCP) with insertion of metal stents in unresectable malignant distal biliary obstruction (MDBO) and the results were conflicting. The aim of the current study was to compare the outcomes of the procedures in a large-scale study.
This was a multicenter international randomized controlled study. Consecutive patients admitted for obstructive jaundice due to unresectable MDBO were recruited. Patients were randomly allocated to receive EUS-guided choledocho-duodenostomy (ECDS) or ERCP for drainage. The primary outcome was the 1-year stent patency rate. Other outcomes included technical success, clinical success, adverse events, time to stent dysfunction, reintervention rates, and overall survival.
Between January 2017 and February 2021, 155 patients were recruited (ECDS 79, ERCP 76). There were no significant differences in 1-year stent patency rates (ECDS 91.1% vs ERCP 88.1%, P = .52). The ECDS group had significantly higher technical success (ECDS 96.2% vs ERCP 76.3%, P < .001), whereas clinical success was similar (ECDS 93.7% vs ERCP 90.8%, P = .559). The median (interquartile range) procedural time was significantly shorter in the ECDS group (ECDS 10 [5.75–18] vs ERCP 25 [14–40] minutes, P < .001). The rate of 30-day adverse events (P = 1) and 30-day mortality (P = .53) were similar.
Both procedures could be options for primary biliary drainage in unresectable MDBO. ECDS was associated with higher technical success and shorter procedural time then ERCP. Primary ECDS may be preferred when difficult ERCPs are anticipated. This study was registered to Clinicaltrials.gov NCT03000855.

View all citing articles on Scopus

: DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: R. Z. Sharaiha: Consultant for Boston Scientific; M. Kahaleh: Consultant for and research grant recipient from Olympus and Boston Scientific; research grant recipient from Gore. All other authors disclosed no financial relationships relevant to this publication.

: If you would like to chat with an author of this article, you may contact Dr Kahaleh at [email protected].

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Systematic review and meta-analysisEfficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis

Background and Aims

Methods

Results

Conclusions

Graphical Abstract

Section snippets

Methods

Search strategy yield and quality assessment

Discussion

Clin Gastroenterol Hepatol

Am J Surg

Control Clin Trials

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastroenterology

Endoscopic ultrasound guided therapy of benign and malignant biliary obstruction: a case series

Am J Gastroenterol

Endoscopic ultrasound-guided choledochoduodenostomy in patients with failed endoscopic retrograde cholangiopancreatography

World J Gastroenterol

Drainage-related complications in percutaneous transhepatic biliary drainage: an analysis over 10 years

J Clin Gastroenterol

Analysis of percutaneous transhepatic cholangioscopy-related complications and the risk factors for those complications

Endoscopy

Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage

Endoscopy

Systematic review and meta-analysis
Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis