Abstract
Background
Recent advances have led to the development of transmural endoscopic ultrasound guided
biliary drainage (EUS-BD) for cases where the duodenal papilla cannot be accessed.
Objectives
We performed a meta-analysis comparing efficacy and complications of both approaches
for biliary drainage.
Review methods
English articles were searched in PubMed. Primary outcomes included technical success
and complications. Secondary outcomes were clinical success and subsequent stent malfunction.
Patient demographics and etiology of obstruction were collected and relative risk
ratios and 95% CIs were calculated. P-value <0.05 was considered as statistically
significant.
Results
Initial database search yielded 245 studies from which 7 were chosen based upon inclusion
criteria for final analysis. There was no statistically different relative risk for
technical success when comparing primary EUS-BD to endoscopic retrograde cholangiopancreatography
(ERCP) (RR: 1.04) or overall procedural complication rate (RR 1.39). EUS-BD did have
increased specific risk of cholangitis (RR: 3.01). Likewise, primary EUS-BD and ERCP
had similar RR for clinical success (RR: 1.02) and overall stent malfunction (RR:
1.55), but stent migration was higher in the primary EUS-BD group (RR: 5.06).
Conclusions
Primary EUS-BD may be considered when the ampulla cannot be accessed, when there is
gastric outlet obstruction, or presence of a duodenal stent.
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Article info
Publication history
Published online: March 06, 2023
Accepted:
March 3,
2023
Received:
August 5,
2022
Publication stage
In Press Uncorrected ProofIdentification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
