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

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 Endoscopic ultrasound versus endoscopic retrograde cholangiopancreatography-guided biliary drainage for primary decompression of malignant biliary obstruction: protocol for a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028156
Author(s):  
Zheng Jin ◽  
Yaping Wei ◽  
Huapeng Lin ◽  
Haitao Huang ◽  
Wen Lv ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Malignant Biliary Obstruction ◽  
Controlled Trials ◽  
Endoscopic Retrograde ◽  
Randomised Controlled

IntroductionCurrent evidence supporting the utility of endoscopic ultrasound-guided biliary drainage (EUS-BD) as a first-line treatment option for malignant biliary obstruction (MBO) is limited. We plan to provide a systematic review and meta-analysis to compare the performance of EUS-BD and endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD) as primary palliation of MBO.Methods and analysisRandomised controlled trials evaluating EUS-BD versus ERCP-BD in primary drainage of MBO will be searched in MEDLINE, EMBASE, Web of Science, the Cochrane Library, ClinicalTrials.gov and Google Scholar, from database inception to 31 October 2018. Data on study design, participant characteristics, intervention details and outcomes will be extracted. Primary outcomes to be assessed are technical and clinical success. Secondary outcomes include adverse events, stent patency, stent dysfunction, reinterventions, procedure duration and overall survival. Study quality will be assessed using the Cochrane Risk of Bias Tool. Meta-analysis will be performed using RevMan V.5.3 statistical software. Data will be combined with a random effect model. The results will be presented as a risk ratio for dichotomous data, weighted mean difference for continuous data and HR for time-to-event data. Publication bias will be visualised using funnel plots.Ethics and disseminationThis study will not use primary data, and therefore, formal ethical approval is not required. The findings will be disseminated through peer-reviewed journals and committee conferences.PROSPERO registration numberCRD42018117040

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

2019 ◽  
Vol 07 (11) ◽  
pp. E1432-E1441 ◽  
Author(s):  
Kelly E. Hathorn ◽  
Ahmad Najdat Bazarbashi ◽  
Jordan S. Sack ◽  
Thomas R. McCarty ◽  
Thomas J. Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Clinical Success ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Primary Treatment ◽  
Malignant Biliary Obstruction ◽  
Comparable Efficacy ◽  
Clinical Scenarios

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.

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