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
Abstract
BACKGROUND

For palliation of malignant biliary obstruction (MBO), the gold-standard method of biliary drainage is endoscopic retrograde cholangiopancreatography (ERCP) with the placement of metallic stents. Endoscopic ultrasound (EUS)-guided drainage is an alternative that is typically reserved for cases of ERCP failure. Recently, however, there have been robust randomized clinical trials (RCTs) comparing EUS-guided drainage and ERCP as primary approaches to MBO.

AIM

To compare EUS guidance and ERCP in terms of their effectiveness and safety in palliative biliary drainage for MBO.

METHODS

This was a systematic review and meta-analysis, in which we searched the MEDLINE, Excerpta Medica, and Cochrane Central Register of Controlled Trials databases. Only RCTs comparing EUS and ERCP for primary drainage of MBO were eligible. All of the studies selected provided data regarding the rates of technical and clinical success, as well as the duration of the procedure, adverse events, and stent patency. 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.

RESULTS

The database searches yielded 5920 records, from which we selected 3 RCTs involving a total of 222 patients (112 submitted to EUS and 110 submitted to ERCP). In the EUS and ERCP groups, the rate of technical success was 91.96% and 91.81%, respectively, with a risk difference (RD) of 0.00% (95%CI: -0.07, 0.07; P = 0.97; I2 = 0%). The clinical success was 84.81% and 85.53% in the EUS and ERCP groups, respectively, with an RD of −0.01% (95%CI: -0.12, 0.10; P = 0.90; I2 = 0%). The mean difference (MD) for the duration of the procedure was -0.12% (95%CI: -8.20, 7.97; P = 0.98; I2 = 84%). In the EUS and ERCP groups, there were 14 and 25 adverse events, respectively, with an RD of -0.06% (95%CI: -0.23, 0.12; P = 0.54; I2 = 77%). The MD for stent patency was 9.32% (95%CI: -4.53, 23.18; P = 0.19; I2 = 44%). The stent dysfunction rate was significantly lower in the EUS group (MD = -0.22%; 95CI:-0.35, -0.08; P = 0.001; I2 = 0%).

CONCLUSION

EUS represents an interesting alternative to ERCP for MBO drainage, demonstrating lower stent dysfunction rates compared with ERCP. Technical and clinical success, duration, adverse events and patency rates were similar.

Keywords: : Common bile duct neoplasms, Endoscopic retrograde cholangiopancreatography, Endosonography, Ultrasonography, Interventional/methods, Endoscopic ultrasound, Systematic review, Meta-analysis

Core tip: No consensus is available in the literature regarding whether endoscopic retrograde cholangiopancreatography or endoscopic ultrasound-guided biliary drainage is more beneficial to the patient. This is the first systematic review and meta-analysis comparing the two methods. We investigated these two techniques in terms of technical and clinical success, as well as duration of the procedure, adverse events, stent dysfunction and stent patency.