EUS-guided biliary drainage in patients with distal malignant biliary obstruction requires fewer interventions and has a lower cost compared to ERCP biliary drainage

2020 ◽  
Author(s):  
Félix I. Téllez-Ávila ◽  
Mónica Auxiliadora Figueredo-Zacarías ◽  
Everardo Muñoz-Anaya ◽  
José Froylan Rodríguez-Sánchez ◽  
Jesús Ramírez-García ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Lower Cost ◽  
Malignant Biliary Obstruction ◽  
Distal Malignant Biliary Obstruction

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

2019 ◽  
Vol 07 (11) ◽  
pp. E1563-E1573 ◽  
Author(s):  
Corey S. Miller ◽  
Alan N. Barkun ◽  
Myriam Martel ◽  
Yen-I Chen
Keyword(s):  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Randomized Trials ◽  
Clinical Success ◽  
Meta Analysis ◽  
Malignant Biliary Obstruction ◽  
First Line ◽  
First Line Therapy ◽  
Catheter Dysfunction ◽  
Distal Malignant Biliary Obstruction

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.

scholarly journals Current Status of Endoscopic Biliary Drainage in Patients with Distal Malignant Biliary Obstruction

2021 ◽  
Vol 10 (19) ◽  
pp. 4619
Author(s):  
Yuki Tanisaka ◽  
Masafumi Mizuide ◽  
Akashi Fujita ◽  
Tomoya Ogawa ◽  
Hiromune Katsuda ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Preoperative Biliary Drainage ◽  
Malignant Biliary Obstruction ◽  
Current Status ◽  
Endoscopic Biliary Drainage ◽  
Metal Stent ◽  
Stent Patency ◽  
First Choice ◽  
Distal Malignant Biliary Obstruction

Distal malignant biliary obstruction is caused by various malignant diseases that require biliary drainage. In patients with operable situations, preoperative biliary drainage is required to control jaundice and cholangitis until surgery. In view of tract seeding, endoscopic biliary drainage is the first choice. Since neoadjuvant therapies are being developed, the time to surgery is increasing, especially in pancreatic cancer cases. Therefore, it requires long stent patency. Recently, preoperative biliary drainage using self-expandable metal stents has been reported as a useful modality to secure long stent patency. In patients with unresectable distal malignant biliary obstruction, self-expandable metal stent is the first choice for maintaining long stent patency. Although there are many comparison studies between a covered and an uncovered self-expandable metal stent, their use is still controversial. Recently, endoscopic ultrasound-guided biliary drainage has been performed as an alternative treatment. The clinical success and stent patency are favorable. We should take into consideration that both endoscopic retrograde cholangiopancreatography-guided biliary drainage and endoscopic ultrasound-guided biliary drainage have advantages and disadvantages and chose the drainage method depending on the patient’s situation or the expertise of the endoscopist. Here, we discuss the current status of endoscopic biliary drainage in patients with distal malignant biliary obstruction.

Su1222 WHICH TECHNIQUE IS BETTER: EUS VS ERCP GUIDED BILIARY DRAINAGE FOR DISTAL MALIGNANT BILIARY OBSTRUCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

2019 ◽  
Vol 89 (6) ◽  
pp. AB322-AB323
Author(s):  
Viveksandeep Thoguluva Chandrasekar ◽  
Ramprasad Jegadeesan ◽  
Seemeen Hassan ◽  
Muhammad Aziz ◽  
Abhiram Duvvuri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Meta Analysis ◽  
Malignant Biliary Obstruction ◽  
Distal Malignant Biliary Obstruction
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