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World J Meta-Anal. Sep 18, 2026; 14(3): 124719
Published online Sep 18, 2026. doi: 10.13105/wjma.124719
Published online Sep 18, 2026. doi: 10.13105/wjma.124719
Endoscopic ultrasound-guided biliary drainage vs endoscopic retrograde cholangiopancreatography for malignant distal obstruction: Randomized-trial meta-analysis
Ahmed Salman, Department of Internal Medicine, Kasr Alainy School of Medicine, Cairo 11562, Egypt
Mohamed AbdAlla Salman, Department of General Surgery, Kasralainy School of Medicine, Cairo 11562, Egypt
Hossam E Shaaban, Department of Internal Medicine and Gastroenterology, National Hepato
Author contributions: Salman A designed research; Salman A, Salman MA, and Shaaban HE performed research; Salman A, Salman MA, and Shaaban HE analyzed data; Salman A wrote the paper; Salman MA and Shaaban HE critically revised the paper; and all authors approved the final manuscript.
AI contribution statement: OpenAI Codex (GPT-6.5) was used to assist with literature-search organization, language polishing, and figure preparation. The authors independently verified study eligibility, references, interpretation, and conclusions, and take full responsibility for the accuracy, originality, and integrity of the manuscript.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Check-list.
Corresponding author: Ahmed Salman, MD, FRACP, FRCP, Department of Internal Medicine, Kasr Alainy School of Medicine, 1 Al-Saray Street, Al-Manial, Cairo 11562, Egypt.
Received: June 23, 2026
Revised: August 13, 2026
Accepted: September 1, 2026
Published online: September 18, 2026
Processing time: 80 Days and 23.8 Hours
Revised: August 13, 2026
Accepted: September 1, 2026
Published online: September 18, 2026
Processing time: 80 Days and 23.8 Hours
Core Tip
Core Tip: This randomized meta-analysis included six trials and 739 participants. Primary transmural ultrasound-guided and retrograde biliary drainage achieved comparable clinical success rates. Ultrasound-guided drainage reduced post-procedural pancreatitis from 6.6% to 0.5%, with concordant rare-event sensitivity analyses. Technical success varies across devices and trials, whereas its effects on other adverse events and repeat interventions remain uncertain. Evidence supports ultrasound-guided drainage as an alternative for selected patients in expert centers, and not as a universal replacement for retrograde drainage.