Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2019; 11(4): 281-291
Published online Apr 16, 2019. doi: 10.4253/wjge.v11.i4.281
Endoscopic ultrasound-guided vs endoscopic retrograde cholangiopancreatography biliary drainage for obstructed distal malignant biliary strictures: A systematic review and meta-analysis
Fernanda P Logiudice, Wanderlei M Bernardo, Facundo Galetti, Vitor M Sagae, Carolina O Matsubayashi, Antonio C Madruga Neto, Vitor O Brunaldi, Diogo T H de Moura, Tomazo Franzini, Spencer Cheng, Sergio E Matuguma, Eduardo G H de Moura
Fernanda P Logiudice, Wanderlei M Bernardo, Facundo Galetti, Vitor M Sagae, Carolina O Matsubayashi, Antonio C Madruga Neto, Vitor O Brunaldi, Tomazo Franzini, Spencer Cheng, Sergio E Matuguma, Eduardo G H de Moura, Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
Diogo T H de Moura, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
Author contributions: Logiudice FP acquisition of data, analysis, interpretation of data, drafting the article, revising the article, final approval; Bernardo WM analysis and interpretation of data, drafting the article, final approval; Galetti F acquisition of data, drafting the article, revising the article; Sagae VM acquisition of data, drafting the article, revising the article; Matsubayashi CO acquisition of data, drafting the article, revising the article; Madruga Neto AC acquisition of data, drafting the article, revising the article, final approval; Brunaldi VO analysis and interpretation of data, critical revision, final approval; de Moura DTH analysis and interpretation of data, revised the article; Franzini T analysis and interpretation of data, drafting the article, revising the article, final approval; Cheng S analysis and interpretation of data, drafting the article, revising the article, final approval; Matuguma E analysis and interpretation of data, drafting the article, revising the article, final approval; de Moura EGH conception and design of the study, critical revision, final approval.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fernanda P Logiudice, MD, Attending Doctor, Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar 255, Instituto Central, Prédio dos Ambulatórios, Pinheiros, São Paulo 05403-010, Brazil. fernanda.logiudice@gmail.com
Telephone: +55-11-997311353 Fax: +55-11-26616467
Received: February 2, 2019
Peer-review started: February 11, 2019
First decision: March 11, 2019
Revised: March 18, 2019
Accepted: March 26, 2019
Article in press: March 26, 2019
Published online: April 16, 2019
ARTICLE HIGHLIGHTS
Research background

Endoscopic retrograde cholangiopancreatography (ERCP) is currently the gold standard palliation approach for distal malignant biliary obstruction (MBO) but as endoscopic ultrasound (EUS)-guided techniques develop and became more commonly available question arises whether EUS-guided biliary drainage cloud be a first line method for treatment of distal MBO.

Research motivation

EUS-guided biliary drainage and ERCP are recognized endoscopic approaches for palliation of MBO. Our initial motivation was to compare EUS and ERCP techniques for primary drainage of distal MBO. By performing a systematic review and meta-analysis following a rigorous methodological approach we aimed to increase the available knowledge regarding endoscopic palliation of MBO.

Research objectives

To perform a systematic review and meta-analysis comparing EUS and ERCP as primary methods of biliary drainage in distal MBO regarding technical success, clinical success, duration of the procedure, adverse events, stent patency and stent dysfunction.

Research methods

We conducted a systematic review and meta-analysis based on the PRISMA Statement and registered on PROSPERO international database. We searched the Medline, Excerpta Medica, and Cochrane Central Register of Controlled Trials databases. Only randomized clinical trials (RCTs) comparing EUS and ERCP for primary drainage of MBO were eligible. We assessed the risk of biases using the Jadad score and the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation criteria.

Research results

Three RCTs were included in the final analysis comprising a total of 222 patients (112 submitted to EUS and 110 submitted to ERCP). The stent dysfunction rate was significantly lower in the EUS group (MD = −0.22%; 95%CI: −0.35, −0.08; P = 0.001; I2 = 0%). There were no statistically significant difference regarding technical success, clinical success, duration of the procedure, adverse events and stent patency among the compared techniques.

Research conclusions

In palliative drainage of distal MBO, EUS-guided and ERCP drainage presents similar rates of technical success, clinical success, adverse events, and stent patency. The rates of stent dysfunction appear to be lower for stents placed under EUS guidance.

Research perspectives

We considered meaningful to stablish a present evaluation of both techniques and as the procedures continue to develop, further widespread and new technologies emerge, we encourage that additional RCT’s and meta-analisys are performed.Cost-effectiveness studies might solidify the role of EUS-guided drainage in the management of MBO.