Open Access
CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(11): E1432-E1441
DOI: 10.1055/a-0990-9488
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

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

Authors

  • Kelly E. Hathorn*

    1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital. Harvard Medical School, Boston, Massachusetts, United States
  • Ahmad Najdat Bazarbashi*

    1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital. Harvard Medical School, Boston, Massachusetts, United States
  • Jordan S. Sack

    1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital. Harvard Medical School, Boston, Massachusetts, United States
  • Thomas R. McCarty

    1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital. Harvard Medical School, Boston, Massachusetts, United States
  • Thomas J. Wang

    2   Division of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
  • Walter W. Chan

    1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital. Harvard Medical School, Boston, Massachusetts, United States
  • Christopher C. Thompson

    1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital. Harvard Medical School, Boston, Massachusetts, United States
  • Marvin Ryou

    1   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital. Harvard Medical School, Boston, Massachusetts, United States
Further Information

Publication History

submitted 21 March 2019

accepted after revision 05 July 2019

Publication Date:
22 October 2019 (online)

Preview

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.

* These authors contributed equally


Supplemental Figs. 1 – 9, Supplemental Table