Endoscopy 2019; 51(04): S95
DOI: 10.1055/s-0039-1681450
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 08:30 – 10:30: EUS therapeutic bile South Hall 1B
Georg Thieme Verlag KG Stuttgart · New York

EUS GUIDED VERSUS ERCP GUIDED BILIARY DRAINAGE FOR PRIMARY PALLIATION OF MALIGNANT BILIARY STRICTURES: A SYSTEMATIC REVIEW AND META-ANALYSIS

A Tringali
1   Endoscopy, ASST Grande Ospedale Niguarda, Milano, Italy
,
E Stasi
2   Gastroenterology and Endoscopy, IRCCS De Bellis, Castellana Grotte, Italy
,
M Cintolo
1   Endoscopy, ASST Grande Ospedale Niguarda, Milano, Italy
,
F Pugliese
1   Endoscopy, ASST Grande Ospedale Niguarda, Milano, Italy
,
L Dioscoridi
1   Endoscopy, ASST Grande Ospedale Niguarda, Milano, Italy
,
E Forti
1   Endoscopy, ASST Grande Ospedale Niguarda, Milano, Italy
,
M Mutignani
1   Endoscopy, ASST Grande Ospedale Niguarda, Milano, Italy
,
DG Adler
3   Gastroenterology and Hepatology, University of Utah, Salt Lake City, United States
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Publikationsverlauf

Publikationsdatum:
18. März 2019 (online)

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Aims:

EUS guided biliary drainage (EU-BD) has emerged as an alternative treatment for Percutaneous transhepatic biliary drainage (PTH-BD) when ERCP fails. EUS-BD has some theoretical advantages over ERCP-BD because it avoids the traumatism of the papilla and allows drainage when the papilla is not reachable. We performed a meta-analysis to assess the role of EUS-BD compared to ERCP-BD in patients with malignant biliary strictures.

Methods:

a literature search using PUBMED and EMBASE was performed to identify article comparing EUS-BD vs. ERCP-BD in patients with distal malignant biliary strictures. Outcome measures were technical and clinical success, overall adverse events, PEP, bleeding, perforation, cholangitis and migration rate, re-intervention rate, procedure time, and patients survival. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI). Fixed and random models were used as appropriate. Heterogeneity was assessed by measuring I2.

Results:

We identified 4 studies for a total of 446 patients (208 EUS-BD, 235 ERCP-BD). No difference emerged in rates of technical (OR 0.75 95% CI 0.26 – 2.16) and clinical success (OR 0.63 95% CI 0.30 – 1.34), need for reintervention (OR 0.61 95% CI 0.09 – 3.90), overall AE (OR 0.60 95% CI 0.33 – 1.09) and cholangitis (OR 0.59 95% CI 0.09 – 3.81). PEP rate was higher in the ERCP-BD group (OR 0.07 95% CI 0.01 – 0.36). There was a trend in the procedure time favoring the EUS-BD group but not reaching statistical significance (MD -5.44 95% CI -11.64 – 0.75). Stent survival was higher in the ERCP-BD group (HR 1.90 95% CI 1.13 – 3.22) while there was not a statistically significant difference in patients survival (HR 0.97 95% CI 0.25 – 3.86).

Conclusions:

EUS-BD was equal to ERCP-BD in efficacy and safety although EUS-BD appears to be associated with a lower rate of PEP and a trend in lower procedure time while ERCP-BD had higher stent survival rates. Further RCTs are needed before a firm conclusion can be made.