Endoscopic ultrasound-guided vs endoscopic retrograde cholangiopancreatography biliary drainage for obstructed distal malignant biliary strictures: A systematic review and meta-analysis

Table 3 Quality (certainty) of evidence of the studies selected, as determined by the GRADE criteria

Parameter	Risk of bias	Inconsistency	Indirectness	Imprecision	Publication bias	Overall certainty of evidence
No. of patients (studies)
Technical success
222 (3 RCTs)	Not serious	Not serious	Not serious	Seriousa	None	Moderate
Clinical success
155 (2 RCTs)	Seriousb	Not serious	Seriousc	Seriousa	None	Very low
Procedure duration
222 (3 RCTs)	Not serious	Very seriousd	Seriouse	Seriousa	None	Very low
Adverse events
222 (3 RCTs)	Not serious	Very seriousd	Not serious	Seriousa	None	Very low
Stent patency
97 (2 RCTs)	Seriousb	Not serious	Seriouse	Seriousa	None	Very low
Stent dysfunction
155 (2 RCTs)	Not serious	Not serious	Seriouse	Not serious	Strongly suspected	Low

^aNo significant difference found. ^bIncomplete outcome data in one study. ^cStudies used different criteria for clinical success. ^dI² > 75%. ^eOutlier identified. RCTs: Randomized clinical trials.