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CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(11): E1563-E1573
DOI: 10.1055/a-0998-8129
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Endoscopic ultrasound-guided biliary drainage for distal malignant obstruction: a systematic review and meta-analysis of randomized trials

Corey S. Miller
Division of Gastroenterology and Hepatology, McGill University Health Center, McGill University, Montréal, Quebec, Canada
,
Alan N. Barkun
Division of Gastroenterology and Hepatology, McGill University Health Center, McGill University, Montréal, Quebec, Canada
,
Myriam Martel
Division of Gastroenterology and Hepatology, McGill University Health Center, McGill University, Montréal, Quebec, Canada
,
Yen-I Chen
Division of Gastroenterology and Hepatology, McGill University Health Center, McGill University, Montréal, Quebec, Canada
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Publikationsverlauf

submitted 25. April 2019

accepted after revision 29. Juli 2019

Publikationsdatum:
11. November 2019 (online)

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Abstract

Background and study aims Endoscopic ultrasound (EUS)-guided biliary drainage (BD) is increasingly used for distal malignant biliary obstruction, yet its safety and efficacy compared to endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD) remain unclear. We performed a meta-analysis to improve our understanding of the role of EUS-BD in this patient population.

Methods We searched Embase, MEDLINE, CENTRAL, and ISI Web of Knowledge through September 2018 for randomized controlled trials (RCTs) comparing EUS-BD to ERCP-BD or PTBD as treatment of distal malignant biliary obstruction. Risk ratios (RRs) with 95 % confidence intervals (CIs) were combined using random effects models. The primary outcome was risk of stent/catheter dysfunction requiring reintervention.

Results Of six trials identified, three (n = 222) compared EUS-BD to ERCP-BD for first-line therapy; three others (n = 132) evaluated EUS-BD versus PTBD after failed ERCP-BD. EUS-BD was associated with a decreased risk of stent/catheter dysfunction overall (RR, 0.39; 95 %CI 0.27 – 0.57) and in planned subgroup analysis when compared to ERCP (RR, 0.41; 95 %CI 0.23 – 0.74) or PTBD (RR, 0.37, 95 %CI 0.22 – 0.61). Compared to ERCP, EUS was associated with a decreased risk of post-procedure pancreatitis (RR, 0.12; 95 %CI 0.01 – 0.97). No differences were noted in technical or clinical success.

Conclusions In a meta-analysis of randomized trials comparing EUS-BD to conventional biliary drainage modalities, no difference in technical or clinical success was observed. Importantly, EUS-BD was associated with decreased risks of stent/catheter dysfunction when compared to both PTBD and ERCP, and decreased post-procedure pancreatitis when compared to ERCP, suggesting the potential role for EUS-BD as an alternative first-line therapy in distal malignant biliary obstruction.

Appendices

 

  • References

  • 1 Boulay BR, Birg A. Malignant biliary obstruction: From palliation to treatment. World J Gastrointest Oncol 2016; 8: 498-508
    CrossrefPubMedSuche in Google Scholar
  • 2 Eloubeidi MA, Decker GA, Chandrasekhara V. et al. The role of endoscopy in the evaluation and management of patients with solid pancreatic neoplasia. Gastrointest Endosc 2016; 83: 17-28
    CrossrefPubMedSuche in Google Scholar
  • 3 Freeman ML, Nelson DB, Sherman S. et al. Complications of endoscopic biliary sphincterotomy. NEJM 1996; 335: 909-918
    CrossrefPubMedSuche in Google Scholar
  • 4 Kochar B, Akshintala VS, Afghani E. et al. Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc 2015; 81: 143-149 e149
    CrossrefPubMedSuche in Google Scholar
  • 5 Moss AC, Morris E, Mac Mathuna P. Palliative biliary stents for obstructing pancreatic carcinoma. Cochrane Database Syst Rev 2006; CD004200
    PubMedSuche in Google Scholar
  • 6 Barkun AN, Adam V, Martel M. et al. Partially covered self-expandable metal stents versus polyethylene stents for malignant biliary obstruction: a cost-effectiveness analysis. Can J Gastroenterol Hepatol 2015; 29: 377-383
    PubMedSuche in Google Scholar
  • 7 Giovannini M, Moutardier V, Pesenti C. et al. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy 2001; 33: 898-900
    Thieme ConnectPubMedSuche in Google Scholar
  • 8 Khashab MA, Van der Merwe S, Kunda R. et al. Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography. Endosc Int Open 2016; 4: E487-496
    Thieme ConnectPubMedSuche in Google Scholar
  • 9 Sharaiha RZ, Khan MA, Kamal F. et al. Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis. Gastrointest Endosc 2017; 85: 904-914
    CrossrefPubMedSuche in Google Scholar
  • 10 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
    CrossrefPubMedSuche in Google Scholar
  • 11 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
    CrossrefPubMedSuche in Google Scholar
  • 12 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
    CrossrefPubMedSuche in Google Scholar
  • 13 Khan MA, Akbar A, Baron TH. et al. Endoscopic ultrasound-guided biliary drainage: A systematic review and meta-analysis. Dig Dis Sci 2016; 61: 684-703
    CrossrefPubMedSuche in Google Scholar
  • 14 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151: 264-269, W64
    PubMedSuche in Google Scholar
  • 15 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
    CrossrefPubMedSuche in Google Scholar
  • 16 Trotti A, Colevas AD, Setser A. et al. CTCAE v3. 0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 2003; 13: 176-181
    PubMedSuche in Google Scholar
  • 17 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
    CrossrefPubMedSuche in Google Scholar
  • 18 Hardy RJ, Thompson SG. Detecting and describing heterogeneity in meta-analysis. Stat Med 1998; 17: 841-856
    CrossrefPubMedSuche in Google Scholar
  • 19 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539-1558
    CrossrefPubMedSuche in Google Scholar
  • 20 Sweeting MJ, Sutton AJ, Lambert PC. What to add to nothing? Use and avoidance of continuity corrections in meta-analysis of sparse data. Stat Med 2004; 23: 1351-1375
    CrossrefPubMedSuche in Google Scholar
  • 21 Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088-1101
    CrossrefPubMedSuche in Google Scholar
  • 22 Egger M, Davey Smith G, Schneider M. et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634
    CrossrefPubMedSuche in Google Scholar
  • 23 Artifon EL, Aparicio D, Paione JB. et al. Biliary drainage in patients with unresectable, malignant obstruction where ERCP fails: endoscopic ultrasonography-guided choledochoduodenostomy versus percutaneous drainage. J Clin Gastroenterol 2012; 46: 768-774
    CrossrefPubMedSuche in Google Scholar
  • 24 Lee TH, Choi JH, Park do H. 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
    CrossrefPubMedSuche in Google Scholar
  • 25 Giovannini M, Bories E, Napoleon B. et al. 855 Multicenter randomized phase II Study: Percutaneous biliary drainage vs EUS guided biliary drainage: Results of the intermediate analysis. Gastrointest Endosc 2015; 81: AB174
    PubMedSuche in Google Scholar
  • 26 Conroy T, Desseigne F, Ychou M. et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. NEJM 2011; 364: 1817-1825
    CrossrefPubMedSuche in Google Scholar
  • 27 Conroy T, Hammel P, Hebbar M. et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. NEJM 2018; 379: 2395-2406
    CrossrefPubMedSuche in Google Scholar
  • 28 Kindler HL. A glimmer of hope for pancreatic cancer. NEJM 2018; 379: 2463-2464
    CrossrefPubMedSuche in Google Scholar
  • 29 Dhir M, Malhotra GK, Sohal DPS. et al. Neoadjuvant treatment of pancreatic adenocarcinoma: a systematic review and meta-analysis of 5520 patients. World J Surg Oncol 2017; 15: 183
    CrossrefPubMedSuche in Google Scholar
  • 30 Varadarajulu S, Hawes RH. EUS-guided biliary drainage: taxing and not ready. Gastrointest Endosc 2013; 78: 742-743
    CrossrefPubMedSuche in Google Scholar
  • 31 Kunda R, Perez-Miranda M, Will U. et al. EUS-guided choledochoduodenostomy for malignant distal biliary obstruction using a lumen-apposing fully covered metal stent after failed ERCP. Surg Endosc 2016; 30: 5002-5008
    CrossrefPubMedSuche in Google Scholar
  • 32 Khashab MA, Messallam AA, Penas I. et al. International multicenter comparative trial of transluminal EUS-guided biliary drainage via hepatogastrostomy vs. choledochoduodenostomy approaches. Endosc Int Open 2016; 4: E175-181
    Thieme ConnectPubMedSuche in Google Scholar
  • 33 Ogura T, Chiba Y, Masuda D. et al. Comparison of the clinical impact of endoscopic ultrasound-guided choledochoduodenostomy and hepaticogastrostomy for bile duct obstruction with duodenal obstruction. Endoscopy 2016; 48: 156-163
    Thieme ConnectPubMedSuche in Google Scholar
  • 34 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
    CrossrefPubMedSuche in Google Scholar
  • 35 Artifon EL, Marson FP, Gaidhane M. et al. Hepaticogastrostomy or choledochoduodenostomy for distal malignant biliary obstruction after failed ERCP: Is there any difference?. Gastrointest Endosc 2015; 81: 950-959
    CrossrefPubMedSuche in Google Scholar
  • 36 Higgins JP, Thompson SG, Spiegelhalter DJ. A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A Stat Soc 2009; 172: 137-159
    CrossrefPubMedSuche in Google Scholar
  • 37 Nagashima K, Noma H, Furukawa TA. Prediction intervals for random-effects meta-analysis: A confidence distribution approach. Stat Methods Med Res 2019; 28: 1689-1702
    CrossrefPubMedSuche in Google Scholar
  • 38 Paik WH, Lee TH, Park DH. et al. Correction: EUS-guided biliary drainage versus ERCP for the primary palliation of malignant biliary obstruction: A multicenter randomized clinical trial. Am J Gastroenterol 2018; 113: 1566
    CrossrefPubMedSuche in Google Scholar