TY - JOUR
T1 - EUS-guided Choledochoduodenostomy Versus Hepaticogastrostomy
AU - Uemura, Ricardo S.
AU - Khan, Muhammad Ali
AU - Otoch, José P.
AU - Kahaleh, Michel
AU - Montero, Edna F.
AU - Artifon, Everson L.A.
N1 - Funding Information:
From the *Department of Surgery, University of Sao Paulo School of Medicine, São Paulo-SP, Brazil; †Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, TN; and ‡Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, NY. M.A.K. has received grants from Boston Scientific, Xlumena, Cook, Olympus, Merit Endotek, MI Tech, Maunakea Tech, W.L. Gore, ASGE. The authors declare that they have nothing to disclose. Address correspondence to: Ricardo S. Uemura, MD, University of Sao Paulo School of Medicine, Ave. Divino Salvador 12, apto 193-B; ZC, Sao Paulo-SP 04078-010, Brazil (e-mail: rsuemura@gmail.com). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MCG.0000000000000948
Publisher Copyright:
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018
Y1 - 2018
N2 - Background and Aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative in cases of endoscopic retrograde cholangiopancreatography (ERCP) failure. Two types of EUS-BD methods for achieving biliary drainage when ERCP fails are choledochoduodenostomy (CDS) or hepaticogastrostomy (HGS). However, there is no consensus if one approach is better than the other. Therefore, we conducted a systematic review and meta-analysis to evaluate these 2 main EUS-BD methods. Methods: We searched MEDLINE, Embase, Scopus, Cochrane database, LILACS from inception through April 8, 2017, using the following search terms in various combinations: biliary drainage, biliary stent, transluminal biliary drainage, choledochoduodenostomy, hepaticogastrostomy, endoscopic ultrasound-guided biliary drainage. We selected studies comparing CDS and HGS in patients with malignant biliary obstruction with ERCP failure. Pooled odds ratio (OR) were calculated for technical success, clinical success, and adverse events and difference of means calculated for duration of procedure and survival after procedure. Results: A total of 10 studies with 434 patients were included in the meta-analysis: 208 underwent biliary drainage via HGS and the remaining 226 via CDS. The technical success for CDS and HGS was 94.1% and 93.7%, respectively, pooled OR=0.96 [95% confidence interval (CI)=0.39-2.33, I 2 =0%]. Clinical success was 88.5% in CDS and 84.5% in HGS, pooled OR=0.76 (95% CI=0.42-1.35, I 2 =17%). There was no difference for adverse events OR=0.97 (95% CI=0.60-1.56), I 2 =37%. CDS was about 2 minutes faster with a pooled difference in means of was -2.69 (95% CI=-4.44 to -0.95). Conclusion: EUS-CDS and EUS-HGS have equal efficacy and safety, and are both associated with a very high technical and clinical success. The choice of approach may be selected based on patient anatomy.
AB - Background and Aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative in cases of endoscopic retrograde cholangiopancreatography (ERCP) failure. Two types of EUS-BD methods for achieving biliary drainage when ERCP fails are choledochoduodenostomy (CDS) or hepaticogastrostomy (HGS). However, there is no consensus if one approach is better than the other. Therefore, we conducted a systematic review and meta-analysis to evaluate these 2 main EUS-BD methods. Methods: We searched MEDLINE, Embase, Scopus, Cochrane database, LILACS from inception through April 8, 2017, using the following search terms in various combinations: biliary drainage, biliary stent, transluminal biliary drainage, choledochoduodenostomy, hepaticogastrostomy, endoscopic ultrasound-guided biliary drainage. We selected studies comparing CDS and HGS in patients with malignant biliary obstruction with ERCP failure. Pooled odds ratio (OR) were calculated for technical success, clinical success, and adverse events and difference of means calculated for duration of procedure and survival after procedure. Results: A total of 10 studies with 434 patients were included in the meta-analysis: 208 underwent biliary drainage via HGS and the remaining 226 via CDS. The technical success for CDS and HGS was 94.1% and 93.7%, respectively, pooled OR=0.96 [95% confidence interval (CI)=0.39-2.33, I 2 =0%]. Clinical success was 88.5% in CDS and 84.5% in HGS, pooled OR=0.76 (95% CI=0.42-1.35, I 2 =17%). There was no difference for adverse events OR=0.97 (95% CI=0.60-1.56), I 2 =37%. CDS was about 2 minutes faster with a pooled difference in means of was -2.69 (95% CI=-4.44 to -0.95). Conclusion: EUS-CDS and EUS-HGS have equal efficacy and safety, and are both associated with a very high technical and clinical success. The choice of approach may be selected based on patient anatomy.
KW - biliary drainage
KW - choledochoduodenostomy
KW - EUS
KW - hepaticogastrostomy
UR - http://www.scopus.com/inward/record.url?scp=85032990140&partnerID=8YFLogxK
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U2 - 10.1097/MCG.0000000000000948
DO - 10.1097/MCG.0000000000000948
M3 - Review article
C2 - 29095426
AN - SCOPUS:85032990140
SN - 0192-0790
VL - 52
SP - 123
EP - 130
JO - Journal of Clinical Gastroenterology
JF - Journal of Clinical Gastroenterology
IS - 2
ER -