Document Type
Article
Publication Date
8-19-2024
Abstract
BACKGROUND: Malignant distal biliary obstruction (MDBO) is a challenging clinical condition commonly managed with endoscopic retrograde cholangiopancreatography (ERCP). However, endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative, especially in complex cases where ERCP fails or is deemed risky. This study aimed to compare the efficacy, safety and cost-effectiveness of EUS-BD vs. ERCP in the palliation of MDBO.
METHODS: We conducted a systematic review and meta-analysis, following PRISMA guidelines. Three databases were searched up to December 2023, including MEDLINE/PubMed, OVID and the Cochrane Central Register of Controlled Trials, for studies comparing EUS-BD with ERCP. Primary outcomes were technical and clinical success rates, while secondary outcomes included procedural times, hospital stay duration, 30-day mortality, reintervention rates, and adverse events such as pancreatitis.
RESULTS: Seven studies involving 1245 patients met the inclusion criteria. The meta-analysis revealed that EUS-BD had a technical success rate of 92%, compared to 85% for ERCP. Clinical success rates were similar for both EUS-BD and ERCP, at approximately 89%. EUS-BD was associated with a significantly lower incidence of pancreatitis (2% vs. 10% for ERCP).
CONCLUSIONS: EUS-BD offers a viable and potentially superior alternative to ERCP for the primary palliation of MDBO, particularly in terms of technical success and a lower risk of pancreatitis. These findings support the adoption of EUS-BD in clinical settings equipped to perform this technique, though future research should focus on long-term outcomes and further economic analysis to solidify these recommendations.
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.
Recommended Citation
Ginnaram, Shravya Reddy; Nugooru, Sudeep; Tahir, Dawood; Devine, Kara; Shaikh, Ali Raza; Yarra, Pradeep; and Walter, James, "Comparative Efficacy of Endoscopic Ultrasound-Guided Biliary Drainage Versus Endoscopic Retrograde Cholangiopancreatography As First-Line Palliation in Malignant Distal Biliary Obstruction: A Systematic Review and Meta-analysis" (2024). Abington Jefferson Health Papers. Paper 116.
https://jdc.jefferson.edu/abingtonfp/116
PubMed ID
39238790
Language
English
Included in
Gastroenterology Commons, Hepatology Commons, Oncology Commons
Comments
This article is the author's final published version in Annals of Gastroenterology, Volume 37, Issue 5, August 2024, pages 602-609.
The published version is available at https://doi.org/10.20524/aog.2024.0912.
Copyright © 2024 Hellenic Society of Gastroenterology.