TY - JOUR
T1 - Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails
T2 - a systematic review and meta-analysis
AU - Sharaiha, Reem Z.
AU - Khan, Muhammad Ali
AU - Kamal, Faisal
AU - Tyberg, Amy
AU - Tombazzi, Claudio R.
AU - Ali, Bilal
AU - Tombazzi, Claudio
AU - Kahaleh, Michel
N1 - Publisher Copyright:
© 2017 American Society for Gastrointestinal Endoscopy
PY - 2017/5
Y1 - 2017/5
N2 - Background and Aims EUS-guided biliary drainage (EUS-BD) is increasingly used as an alternate therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction in patients who fail ERCP. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures. Methods We searched several databases from inception to September 4, 2016 to identify comparative studies evaluating the efficacy and safety of EUS-BD and PTBD. Primary outcomes of interest were the differences in technical success and postprocedure adverse events. Secondary outcomes of interest included clinical success, rate of reintervention, length of hospital stay, and cost comparison for these 2 procedures. Odds ratios (ORs) and standard mean difference were calculated for categorical and continuous variables, respectively. These were analyzed using random effects model of meta-analysis. Results Nine studies with 483 patients were included in the final analysis. There was no difference in technical success between 2 procedures (OR, 1.78; 95% CI, .69-4.59; I2 = 22%) but EUS-BD was associated with better clinical success (OR, .45; 95% CI, .23-.89; I2 = 0%), fewer postprocedure adverse events (OR, .23; 95% CI, .12-.47; I2 = 57%), and lower rate of reintervention (OR, .13; 95% CI, .07-.24; I2 = 0%). There was no difference in length of hospital stay after the procedures, with a pooled standard mean difference of –.48 (95% CI, –1.13 to .16), but EUS-BD was more cost-effective, with a pooled standard mean difference of –.63 (95% CI, –1.06 to –.20). However, the latter 2 analyses were limited by considerable heterogeneity. Conclusions When ERCP fails to achieve biliary drainage, EUS-guided interventions may be preferred over PTBD if adequate advanced endoscopy expertise and logistics are available. EUS-BD is associated with significantly better clinical success, lower rate of postprocedure adverse events, and fewer reinterventions.
AB - Background and Aims EUS-guided biliary drainage (EUS-BD) is increasingly used as an alternate therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction in patients who fail ERCP. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures. Methods We searched several databases from inception to September 4, 2016 to identify comparative studies evaluating the efficacy and safety of EUS-BD and PTBD. Primary outcomes of interest were the differences in technical success and postprocedure adverse events. Secondary outcomes of interest included clinical success, rate of reintervention, length of hospital stay, and cost comparison for these 2 procedures. Odds ratios (ORs) and standard mean difference were calculated for categorical and continuous variables, respectively. These were analyzed using random effects model of meta-analysis. Results Nine studies with 483 patients were included in the final analysis. There was no difference in technical success between 2 procedures (OR, 1.78; 95% CI, .69-4.59; I2 = 22%) but EUS-BD was associated with better clinical success (OR, .45; 95% CI, .23-.89; I2 = 0%), fewer postprocedure adverse events (OR, .23; 95% CI, .12-.47; I2 = 57%), and lower rate of reintervention (OR, .13; 95% CI, .07-.24; I2 = 0%). There was no difference in length of hospital stay after the procedures, with a pooled standard mean difference of –.48 (95% CI, –1.13 to .16), but EUS-BD was more cost-effective, with a pooled standard mean difference of –.63 (95% CI, –1.06 to –.20). However, the latter 2 analyses were limited by considerable heterogeneity. Conclusions When ERCP fails to achieve biliary drainage, EUS-guided interventions may be preferred over PTBD if adequate advanced endoscopy expertise and logistics are available. EUS-BD is associated with significantly better clinical success, lower rate of postprocedure adverse events, and fewer reinterventions.
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U2 - 10.1016/j.gie.2016.12.023
DO - 10.1016/j.gie.2016.12.023
M3 - Review article
C2 - 28063840
AN - SCOPUS:85013481746
SN - 0016-5107
VL - 85
SP - 904
EP - 914
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 5
ER -