Endoscopic ultrasound-guided biliary drainage vs endoscopic retrograde cholangiopancreatography for malignant distal obstruction: Randomized-trial meta-analysis

Table 1 Characteristics of the included randomized trials

Ref.	Setting	EUS/ERCP	Population	Ultrasound-guided route	Stents	Follow-up
Bang et al[9], 2018	United States	33/34	Pancreatic cancer	Choledochoduodenostomy	Tubular covered metal/covered metal	At least 6 months
Park et al[10], 2018	South Korea	14/14 analyzed	Predominantly pancreatic cancer	Transmural drainage	Partially covered tubular metal/metal	Median 95/147 days
Paik et al[8], 2018	South Korea; multicenter	64/61	Unresectable distal obstruction	Choledochoduodenostomy or hepaticogastrostomy	Tubular covered metal/covered metal	To death or dysfunction
Chen et al[11], 2023	Canada/France; multicenter	73/71	Borderline, locally advanced, or unresectable	Choledochoduodenostomy	Lumen-apposing metal/metal	1 year
Teoh et al[12], 2023	International; multicenter	79/76	Unresectable distal obstruction	Choledochoduodenostomy	Lumen-apposing metal/covered metal	1 year
Anderloni et al[13], 2026	Italy; multicenter	111/109	Distal obstruction; common bile duct at least 15 mm	Choledochoduodenostomy	Lumen-apposing metal/covered metal	6 months

EUS: Endoscopic ultrasound; ERCP: Endoscopic retrograde cholangiopancreatography.

Table 2 Summary of pooled outcomes

Outcome	EUS-guided	ERCP	RR (95%CI)	I2	Interpretation
Technical success	350/374	304/365	1.08 (0.96-1.22)	64	No clear difference; inconsistent
Clinical success	331/369	322/359	1.01 (0.95-1.07)	0	Comparable
Procedure-related adverse events	52/374	63/365	0.83 (0.53-1.31)	1	Imprecise
Postprocedural pancreatitis	2/374	24/365	0.20 (0.05-0.77)	0	Lower with ultrasound-guided drainage
Stent dysfunction or reintervention	35/374	56/365	0.60 (0.36-1.01)	0	Possible reduction; uncertain

Risk ratios use Paule-Mandel random effects and modified Hartung-Knapp confidence intervals. CI: Confidence interval; EUS: Endoscopic ultrasound; ERCP: Endoscopic retrograde cholangiopancreatography; RR: Risk ratio.