Endoscopic ultrasound-guided transmural approach versus ERCP-guided transpapillary approach for primary decompression of malignant biliary obstruction: a meta-analysis

Kirles Bishay; Devon Boyne; Mohammad Yaghoobi; Mouen A. Khashab; Risa Shorr; Yervant Ichkhanian; Nauzer Forbes

doi:10.1055/a-0901-7343

Endoscopy, Table of Contents

Endoscopy 2019; 51(10): 950-960
DOI: 10.1055/a-0901-7343

Review

Endoscopic ultrasound-guided transmural approach versus ERCP-guided transpapillary approach for primary decompression of malignant biliary obstruction: a meta-analysis

Authors

Kirles Bishay^*

¹Department of Medicine, Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
Devon Boyne^*

²Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
Mohammad Yaghoobi

³Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada

⁴Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
Mouen A. Khashab

⁵Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
Risa Shorr

⁶Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada
Yervant Ichkhanian

⁵Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
Nauzer Forbes

²Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

⁷Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada

Abstract

Background Primary decompression in patients with malignant biliary obstruction can be achieved via endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary stenting, or, more recently, via transmural endoscopic ultrasound-guided biliary drainage (EUS-BD). It is unclear whether either approach is superior in terms of clinical success or adverse events in the primary setting.

Methods A comprehensive systematic electronic search was performed for studies comparing EUS-BD and ERCP as the primary approach with respect to clinical success and any other outcome(s). Pooled relative risks (RRs) and weighted mean differences were obtained as appropriate using DerSimonian and Laird random effects models. Sensitivity analyses were also performed.

Results 5 out of 776 studies with a total of 396 patients were included. Overall clinical success was not significantly different between EUS-BD and ERCP (RR 0.98, 95 % confidence interval [CI] 0.93 to 1.03). There was no significant difference in overall adverse events (RR 0.84, 95 %CI 0.35 to 2.01), though results suggested that EUS-BD may be associated with a reduced risk of pancreatitis (RR 0.22, 95 %CI 0.05 to 1.02). There were no significant differences between EUS-BD and ERCP in terms of procedure time or the risk of stent occlusion.

Conclusions EUS-BD had similar clinical success rates and occlusion rates to ERCP in the primary decompression of malignant biliary obstruction from meta-analysis including a modest number of patients. EUS-BD may be a practical alternative to the ERCP-guided approach in such patients, but further well-designed prospective studies with larger numbers of patients are required to more clearly delineate potential differences in adverse events and cost.

Full Text

References

References
1 Domagk D, Oppong KW, Aabakken L. et al. Performance measures for ERCP and endoscopic ultrasound: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2018; 50: 1116-1127
2 Donnan E, Bentrem DJ, Komanduri S. et al. ERCP in potentially resectable malignant biliary obstruction is frequently unsuccessful when performed outside of a comprehensive pancreaticobiliary center. J Surg Oncol 2016; 113: 647-651
3 Enochsson L, Swahn F, Arnelo U. et al. Nationwide, population-based data from 11,074 ERCP procedures from the Swedish Registry for Gallstone Surgery and ERCP. Gastrointest Endosc 2010; 72: 1175-1184
4 Nennstiel S, Weber A, Frick G. et al. Drainage-related complications in percutaneous transhepatic biliary drainage: an analysis over 10 years. J Clin Gastroenterol 2015; 49: 764-770
5 Oh HC, Lee SK, Lee TY. et al. Analysis of percutaneous transhepatic cholangioscopy-related complications and the risk factors for those complications. Endoscopy 2007; 39: 731-736
6 Weber A, Gaa J, Rosca B. et al. Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts. Eur J Radiol 2009; 72: 412-417
7 Gan SI, Rajan E, Adler DG. et al. Role of EUS. Gastrointest Endosc 2007; 66: 425-434
8 Fabbri C, Luigiano C, Lisotti A. et al. Endoscopic ultrasound-guided treatments: are we getting evidence based – a systematic review. World J Gastroenterol 2014; 20: 8424-8448
9 Mallery S, Matlock J, Freeman ML. EUS-guided rendezvous drainage of obstructed biliary and pancreatic ducts: report of 6 cases. Gastrointest Endosc 2004; 59: 100-107
10 Wiersema MJ, Sandusky D, Carr R. et al. Endosonography-guided cholangio-pancreatography. Gastrointest Endosc 1996; 43: 102-106
11 Khashab MA, Levy MJ, Itoi T. et al. EUS-guided biliary drainage. Gastrointest Endosc 2015; 82: 993-1001
12 Baars JE, Kaffes AJ, Saxena P. EUS-guided biliary drainage: a comprehensive review of the literature. Endosc Ultrasound 2018; 7: 4-9
13 Wang K, Zhu J, Xing L. et al. Assessment of efficacy and safety of EUS-guided biliary drainage: a systematic review. Gastrointest Endosc 2016; 83: 1218-1227
14 Anderloni A, Fugazza A, Troncone E. et al. Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction. Gastrointest Endosc 2019; 89: 69-76
15 Mariani A, Giussani A, Di Leo M. et al. Guidewire biliary cannulation does not reduce post-ERCP pancreatitis compared with the contrast injection technique in low-risk and high-risk patients. Gastrointest Endosc 2012; 75: 339-346
16 Halttunen J, Meisner S, Aabakken L. et al. Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs. Scand J Gastroenterol 2014; 49: 752-758
17 Bailey AA, Bourke MJ, Williams SJ. et al. A prospective randomized trial of cannulation technique in ERCP: effects on technical success and post-ERCP pancreatitis. Endoscopy 2008; 40: 296-301
18 Moher D, Shamseer L, Clarke M. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4: 1
19 Higgins JPT, Altman DG, Sterne JAC. et al. (eds) Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (eds). Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011 Available from: http://handbook-5-1.cochrane.org/ , Accessed 7 March 2019
20 Wells G, Shea B, O’Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2018 Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp , Accessed 7 March 2019
21 Higgins J, Thompson S. Quantifying heterogeneity in a meta‐analysis. Stat Med 2002; 21: 1539-1558
22 Dhir V, Itoi T, Khashab MA. et al. Multicenter comparative evaluation of endoscopic placement of expandable metal stents for malignant distal common bile duct obstruction by ERCP or EUS-guided approach. Gastrointest Endosc 2015; 81: 913-923
23 Hamada T, Isayama H, Nakai Y. et al. Transmural biliary drainage can be an alternative to transpapillary drainage in patients with an indwelling duodenal stent. Digest Dis Sci 2014; 59: 1931-1938
24 Bapaye A, Mahadik M, Gaadhe R. et al. Stent patency of endoscopic ultrasound guided transmural versus transpapillary biliary drainage in malignant biliary obstruction. J Gastroenterol Hepatol 2016; 31 (Suppl. 03) 228
25 Piyachaturawat P, Kongkam P, Ridtitid W. et al. EUS-guided versus percutaneous versus ERCP biliary drainage in patients with malignant biliary obstruction: a case-controlled study from a large referral center. Gastrointest Endosc 2017; 85: AB476-AB477
26 Paik WH, Lee TH, Park DH. et al. EUS-guided biliary drainage versus ERCP for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial. Am J Gastroenterol 2018; 113: 987-997
27 Bang JY, Navaneethan U, Hasan M. et al. Stent placement by EUS or ERCP for primary biliary decompression in pancreatic cancer: a randomized trial (with videos). Gastrointest Endosc 2018; 88: 9-17
28 Park JK, Woo YS, Noh DH. et al. Efficacy of EUS-guided and ERCP-guided biliary drainage for malignant biliary obstruction: prospective randomized controlled study. Gastrointest Endosc 2018; 88: 277-282
29 Kawakubo K, Kawakami H, Kuwatani M. et al. Endoscopic ultrasound-guided choledochoduodenostomy vs. transpapillary stenting for distal biliary obstruction. Endoscopy 2016; 48: 164-169
30 Ridtitid W, Kongkam P, Angsuwatcharakorn P. et al. Ultimate outcomes of endoscopic transpapillary stenting (ETS) versus EUS-guided choledochoduodenostomy (EUS-CDS) using selfexpandable metallic stent (SEMS) in patients with inoperable malignant distal biliary obstruction. J Gastroenterol Hepatol 2016; 31 (Suppl. 03) 272-273
31 Fu R, Gartlehner G, Grant M. et al. Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program. Rockville (MD): Agency for Healthcare Research and Quality (US); 2010
32 Lee TH, Choi JH, Park doH. et al. Similar efficacies of endoscopic ultrasound-guided transmural and percutaneous drainage for malignant distal biliary obstruction. Clin Gastroenterol Hepatol 2016; 14: 1011-1019.e1013
33 Shah JN, Marson F, Weilert F. et al. Single-operator, single-session EUS-guided anterograde cholangiopancreatography in failed ERCP or inaccessible papilla. Gastrointest Endosc 2012; 75: 56-64
34 Park DH, Jeong SU, Lee BU. et al. Prospective evaluation of a treatment algorithm with enhanced guidewire manipulation protocol for EUS-guided biliary drainage after failed ERCP (with video). Gastrointest Endosc 2013; 78: 91-101
35 Hara K, Yamao K, Hijioka S. et al. Prospective clinical study of endoscopic ultrasound-guided choledochoduodenostomy with direct metallic stent placement using a forward-viewing echoendoscope. Endoscopy 2013; 45: 392-396

Supplementary Material

Supplementary material (PDF) (opens in new window)