Published online Apr 16, 2019. doi: 10.4253/wjge.v11.i4.281
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
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.
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.
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.
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.
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.
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.
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.