Endoscopic ultrasound-guided versus endoscopic retrograde cholangiopancreatography-guided biliary drainage for primary treatment of distal malignant biliary obstruction: A systematic review and meta-analysis

Abstract

Objectives: Current evidence supporting the utility of endoscopic ultrasound-guided biliary drainage (EUS-BD) as primary treatment for distal malignant biliary obstruction (MBO) is limited. We conducted a meta-analysis to compare the performance of EUS-BD and endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD) as primary palliation of distal MBO. Methods: We searched several databases for comparative studies evaluating EUS-BD vs. ERCP-BD in primary drainage of distal MBO up to 28 February 2019. Primary outcomes were technical success and clinical success. Secondary outcomes included adverse events, stent patency, stent dysfunction, tumor in/overgrowth, reinterventions, procedure duration, and overall survival. Results: Four studies involving 302 patients were qualified for the final analysis. There was no difference in technical success (risk ratio [RR] 1.00; 95% confidence interval [95% CI] 0.93–1.08), clinical success (RR 1.00; 95% CI 0.94–1.06) and total adverse events (RR 0.68; 95% CI: 0.31–1.48) between the two procedures. EUS-BD was associated with lower rates of post-procedure pancreatitis (RR 0.12; 95% CI 0.02–0.62), stent dysfunction (RR 0.54; 95% CI 0.32–0.91), and tumor in/overgrowth (RR 0.22; 95% CI 0.07–0.76). No differences were noted in reinterventions (RR 0.59; 95% CI 0.21–1.69), procedure duration (weighted mean difference −2.11; 95% CI −9.51 to 5.29), stent patency (hazard ratio [HR] 0.61; 95% CI 0.34–1.11), and overall survival (HR 1.00; 95% CI 0.66–1.51). Conclusions: With adequate endoscopy expertise, EUS-BD could show similar efficacy and safety when compared with ERCP-BD for primary palliation of distal MBO and exhibits several clinical advantages.