Therapeutic interventional endoscopic ultrasound in pancreato-biliary disorders: Does it really replace the surgical/percutaneous approach?

Table 1 Summary of comparison studies involving endoscopic ultrasound-guided biliary drainage in patients with biliary obstruction

Ref.	Design	Cases	Number of patients	Success rates	Complication rate
Tyberg et al[15]	Retrospective study	Patients with biliary obstruction who failed conventional ERCP	52	Technical success rate: 96%. Clinical success rate: 77%	Adverse events: 10%
Khashab et al[13]	Retrospective comparative cohort study	Patients who underwent EUS-BD or PTBD with distal malignant biliary obstruction after at least one failed ERCP attempt	73	Technical success rate: EUS-BD vs PTBD: 86.4% vs 100%. Clinical success rate: EUS-BD vs PTBD: 86.4% vs 92.2%	Adverse events: EUS-BD vs PTBD: 18.2% vs 39.2%. Re-intervention: EUS-BD vs PTBD: 15.7% vs 80.4%
Sharaiha et al[10]	Systematic review and meta-analysis	Patients who underwent EUS-BD or PTBD with biliary obstruction and failure of ERCP to obtain drainage	483	Technical success rate: OR 1.78 (P = 0.25). Clinical success rate: OR 0.45 (P = 0.66) in favor of EUS-BD	Adverse events: OR 0.23 (P = 0.02). Re-intervention: OR 0.13 (P = 0.77) in favor of EUS-BD
Téllez-Ávila et al[14]	Retrospective comparative study	Patients who underwent EUS-BD or PTBD with biliary obstruction and had at least one previous failed ERCP attempt or difficulty in accessing the second portion of duodenum	90	Technical success rate: EUS-BD vs PTBD: 90% vs 78% (P = 0.3). Clinical success rate: EUS-BD vs PTBD: 96% vs 63% (P = 0.04)	Complications: EUS-BD vs PTBD: 6.6% vs 28% (P = 0.04). Length of hospital stay: EUS-BD vs PTBD: 6.5 d vs 12.5 d (P = 0.009)
Poincloux et al[16]	Retrospective study	Patients with malignant and benign biliary obstruction with previous failed ERCP attempt who underwent EUS intra- or extra-hepatic approach with transluminal stenting or rendezvous procedure with trans-papillary stent placement	101	Technical success rate: 98%. Clinical success rate: 92.1%	Adverse event rate: 11.9%. Six procedure-related deaths
Lesmana et al[12]	Retrospective study	Patients with advanced malignant biliary obstruction, who underwent EUS-BD after failed ERCP attempt	38	Technical success rate: EUS-BD vs PTBD: 87.5%% vs 86.7% (P = 1.000). Clinical success rate: EUS-BD vs PTBD: 62.5% vs 93.3% (P = 0.5)	Adverse events: EUS-BD vs PTBD: 1 patient vs 0 patient
Han et al[17]	Systematic review and meta-analysis	Patients with malignant distal biliary obstruction who underwent EUS-BD with transmural metal stenting or ERCP for primary palliative treatment	756	Technical success rate: EUS-BD vs ERCP: 94.8% vs 96.5%. Clinical success rate: EUS-BD vs ERCP: 93.8% vs 95.7%	Adverse event rate: EUS-BD vs ERCP: 16.3% vs 18.3%
Moole et al[11]	Systematic review and meta-analysis	Patients with inoperable malignant biliary strictures with a failed ERCP attempt, who underwent EUS-BD or PTBD	528	Success rate: EUS-BD vs PTBD (pooled OR): 3.06	Risk difference for overall procedure-related complications in EUS-BD vs PTBD: -0.21. Relative risk for infectious complications and bile leak: EUS-BD vs PTBD: 0.25 vs 0.33
Artifon et al[18]	Prospective and randomized trial	Patients with unresectable malignant distal biliary obstruction (with history of failed standard ERCP) treated with EUS-guided choledochoduodenostomy (EUS-CDT) or surgical biliary bypass or hepaticojejunostomy (HJT)	32	Technical success rates: EUS-CDT vs HJT: 88% vs 94% (P = 0.598). Clinical success rates: EUS-CDT vs HJT: 71% vs 93% (P = 0.169)	Complication rates: EUS-CDT vs HJT: 21.42% vs 13.33% (P = 0.651). Median survival: EUS-CDT vs HJT: 82.36 d vs 82.27 d. 90-d mortality: EUS-CDT vs HJT: 42.9% vs 60% (P = 0.389)

ERCP: Endoscopic retrograde cholangiopancreatography; EUS-BD: Endoscopic ultrasound-guided biliary drainage; PTBD: Percutaneous transhepatic biliary drainage; OR: Odds ratio.