Endoscopic ultrasound-guided biliary drainage vs. endoscopic retrograde cholangiopancreatography for primary drainage in patients with distal malignant biliary obstruction: systematic review and meta-analysis of randomized controlled trials

Aims We aimed to assess the pooled efficacy and safety of Endoscopic ultrasound-guided biliary drainage vs. endoscopic retrograde cholangiopancreatography for primary drainage in patients with distal malignant biliary obstruction.

Methods Database search was performed to identify RCTs comparing EUS-BD to ERCP for primary biliary drainage in patients with DMBO. Primary outcome was technical success. Secondary outcomes were clinical success, adverse events (AEs), severe AEs rate, mean procedure time, 1-year stent patency, and overall survival. Relative risk (RR) with 95% confidence interval (CI) were calculated using fixed-effect model

Results Five studies involving 519 patients were included. Pooled technical success rate was significantly higher in patients who underwent EUS-BD (RR 1.09; [1.03–1.16]; P=0.004), while clinical success was similar (RR 1.01; [0.95–1.08]; P=0.68). 1-year stent patency was significantly higher in EUS-BD group (RR 1.14; [1.05–1.25], P=0.003), with significantly lower reintervention (RR 0.58; [0.38–0.88]; P=0.012). A trend towards a lower AEs (RR 0.69; [0.47–1.01]; P=0.06) and severe AEs (RR 0.97; [0.14–6.82]; P=0.07) was observed in EUS-BD. Procedure time was significantly lower in EUS-BD (standardized mean difference -2.36; [-2.68 to -2.05]; P<0.001). Patients in the EUS-BD arms showed longer overall survival (standardized mean difference 0.58; [0.37 to 0.78]; P<0.001). Subgroup analysis according to type of stent used for EUS-BD showed that the three studies conducted with SEMS accounted for the higher 1-year stent patency rate and for the reduced need for reintervention and incidence of AEs, while the studies conducted with LAMS accounted for the improved technical success rate and reduced mean procedure time

Conclusions EUS-BD could be considered a valid first-line approach for DMBO due to good performance observed. EUS-BD showed higher pooled technical success rate and stent patency compared to ERCP, with similar clinical success rate and safety profile.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
15 April 2024