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CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(11): E1432-E1441
DOI: 10.1055/a-0990-9488
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

EUS-guided biliary drainage is equivalent to ERCP for primary treatment of malignant distal biliary obstruction: a systematic review and meta-analysis

Kelly E. Hathorn‡   *
1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital. Harvard Medical School, Boston, Massachusetts, United States
,
Ahmad Najdat Bazarbashi‡   *
1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital. Harvard Medical School, Boston, Massachusetts, United States
,
Jordan S. Sack
1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital. Harvard Medical School, Boston, Massachusetts, United States
,
Thomas R. McCarty
1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital. Harvard Medical School, Boston, Massachusetts, United States
,
Thomas J. Wang
2   Division of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Walter W. Chan
1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital. Harvard Medical School, Boston, Massachusetts, United States
,
Christopher C. Thompson
1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital. Harvard Medical School, Boston, Massachusetts, United States
,
Marvin Ryou
1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital. Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations
Further Information

Publication History

submitted 21 March 2019

accepted after revision 05 July 2019

Publication Date:
22 October 2019 (online)

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Abstract

Background and study aims Although endoscopic retrograde cholangiopancreatography (ERCP) is standard of care for malignant biliary obstruction, endoscopic ultrasound-guided biliary drainage (EUS-BD) as a primary treatment has become increasingly utilized. The aim of this study was to perform a systematic review and meta-analysis to evaluate the effectiveness and safety of EUS-BD for primary treatment of malignant biliary obstruction and comparison to traditional ERCP.

Methods Individualized search strategies were developed through November 2018 using PRISMA and MOOSE guidelines. A cumulative meta-analysis was performed by calculating pooled proportions. Subgroup analysis was performed for studies comparing EUS-BD versus ERCP. Heterogeneity was assessed with Cochran Q test or I 2 statistics, and publication bias by funnel plot and Egger’s tests.

Results Seven studies (n = 193 patients; 57.5 % males) evaluating primary EUS-BD for malignant biliary obstruction were included. Mean age was 67.4 years (2.3) followed an average of 5.4 months (1.0). For primary EUS-BD, pooled technical success, clinical success, and adverse event (AE) rates were 95 % (95 % CI 91 – 98), 97 % (95 % CI 93 – 100), and 19 % (95 % CI 11 – 29), respectively. Among EUS-BD and ERCP comparator studies, technical and clinical success, and total AEs were not different with lower rates of post-ERCP pancreatitis and reintervention among the EUS-BD group.

Conclusion Primary EUS-BD is an effective treatment with few AE. Comparing EUS-BD versus ERCP, EUS-BD has comparable efficacy and improved safety as a primary treatment for malignant biliary obstruction. Further randomized trials should be performed to identify patient populations and clinical scenarios in which primary EUS-BD would be most appropriate.

* These authors contributed equally


Supplemental Figs. 1 – 9, Supplemental Table

 

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