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 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.

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

Su1210 EUS VERSUS ERCP FOR PRIMARY DRAINAGE OF MALIGNANT BILIARY OBSTRUCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS BASED ON RANDOMIZED TRIALS

2019 ◽  
Vol 89 (6) ◽  
pp. AB317-AB318
Author(s):  
Fernanda P. Logiudice ◽  
Wanderlei M. Bernardo ◽  
Facundo Galetti ◽  
Mateus P. Funari ◽  
Vitor M. Sagae ◽  
...  
Keyword(s):  
Systematic Review ◽  
Biliary Obstruction ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Malignant Biliary Obstruction

scholarly journals Outcomes and Limitations of Endoscopic Ultrasound-guided Hepaticogastrostomy in Malignant Biliary Obstruction

2021 ◽  
Author(s):  
Mateusz Jagielski ◽  
Michał Zieliński ◽  
Jacek Piątkowski ◽  
Marek Jackowski
Keyword(s):  
Gastrointestinal Tract ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Bile Ducts ◽  
Clinical Success ◽  
Hepatic Metastases ◽  
Symptomatic Treatment ◽  
Malignant Biliary Obstruction ◽  
Biliary Duct ◽  
Factors Affecting

Abstract Background: Transpapillary biliary drainage in ERCP is an established method for symptomatic treatment of patients with irresectable malignant biliary obstruction. Percutaneous transhepatic biliary drainage frequently remains the treatment of choice when the transpapillary approach proves ineffective. Recently, EUS-guided extra-anatomical anastomoses of bile ducts to the gastrointestinal tract have been reported as an alternative to percutaneous biliary drainage. To assess the usefulness of extra-anatomical intrahepatic biliary duct anastomoses to the gastrointestinal tract as endotherapy for irresectable malignant biliary obstruction and to determine factors affecting the efficacy of treatment. Methods: A prospective analysis of the treatment results of all patients with irresectable biliary obstruction treated with endoscopic hepaticogastrostomy at our institution in the years 2016–2019. Results: Transmural intrahepatic biliary drainage (endoscopic hepaticogastrostomy) was performed due to the ineffectiveness of ERCP in 53 patients (38 males, 15 females; mean age 74.66 [56–89] years) with irresectable biliary obstruction. Technical success of endoscopic hepaticogastrostomy was achieved in 52/53 (98.11%) patients. Complications of endoscopic treatment were observed in 10/53 (18.87%) patients. Clinical success of endoscopic hepaticogastrostomy was achieved in 46/53 (86.79%) patients. Bismuth type II–IV cholangiocarcinoma, hepatic metastases, ascites, suppurative cholangitis, and high blood bilirubin levels exceeding 30 mg/dL were independent factors for increased complications and inefficacy of endoscopic hepaticogastrostomy. Conclusions: In the event of transpapillary biliary drainage proving ineffective, extra-anatomical anastomoses of bile ducts to the gastrointestinal tract provide an effective method for the treatment of patients with malignant biliary obstruction.

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