BILIARY DRAINAGE IN PATIENTS WITH CHOLANGIOCARCINOMA: A COMPARISON BETWEEN ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AND PERCUTANEOUS TRANSHEPATIC APPROACHES

Aims The aim of this systematic review and meta-analysis is to elucidate which is the optimal approach for biliary drainage in patients with cholangiocarcinoma.

Methods Searches were performed on MEDLINE, Central Cochrane, EMBASE, LILACS, and gray literature with no restrictions regarding the year of publication, to identify studies comparing EBD versus PTBD for patients with cholangiocarcinoma and indication of biliary drainage. Evaluated outcomes were: post drainage complications, post-operative complications, technical success, clinical success, seeding metastases, recurrence, overall survival, 5 year survival, number of procedures and hospital length stay.

The risk of bias was assessed by ROBINS-I tool and the quality of evidence by GRADE tool.

Results A total of twenty-three studies (twenty-two retrospective cohorts and one randomized controlled trial) were included with a total of 4072 patients (EBD: N=2238, PTBD: N=1834). The EBD group demonstrated less postoperative complications (RD -0.07, CI -0.12,-0,01; P=0.03) and lower rate of seeding metastases (RD -0.06, CI -0.12,-0.01; P=0.01). The PTBD group showed less post-drainage complications (RD 0.12, CI 0.03,0.21; P=0.01 ). There was no statistical difference between the groups regarding technical success, clinical success, recurrence, overall survival, 5-year survival, number of procedures and hospital length stay.

Conclusions EBD and PTBD have equivalent technical and clinical success. EBD is superior to PTBD regarding postoperative complications and seeding metastases, whereas PTBD is superior to EBD when it comes to post-drainage complications. Randomized controlled trials should be performed in this field in order to obtain stronger scientific evidence to support the choice between one of the two mentioned approaches.

Publication History

Article published online:
14 April 2022