Efficacy and safety of EUS-guided biliary drainage for benign biliary obstruction – A systematic review and meta-analysis,Endoscopic Ultrasound

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Efficacy and safety of EUS-guided biliary drainage for benign biliary obstruction – A systematic review and meta-analysis
Endoscopic Ultrasound ( IF 4.5 ) Pub Date : 2023-02-06 , DOI: 10.4103/eus-d-22-00077
Faisal Kamal ₁ , Muhammad Ali Khan ₂ , Wade Lee-Smith ₃ , Sachit Sharma ₄ , Ashu Acharya ₅ , Umer Farooq ₆ , Zahid Ijaz Tarar ₇ , Alec E Faggen ₁ , Muhammad Aziz ₈ , Saurabh Chandan ₉ , Zohaib Ahmed ₅ , Abdul Kouanda ₁ , Sun-Chuan Dai ₁ , Craig A Munroe ₁ , Douglas G Adler ₁₀

Affiliation

Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA.
Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Mulford Health Sciences Library, University of Toledo, Toledo, OH, USA.
Division of Gastroenterology, Virginia Commonwealth University, Richmond, VA; Department of Medicine, University of Toledo, Toledo, OH, USA.
Department of Medicine, University of Toledo, Toledo, OH, USA.
Department of Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, IL, USA.
Department of Medicine, University of Missouri, Columbia, MO, USA.
Division of Gastroenterology, University of Toledo, Toledo, OH, USA.
Division of Gastroenterology, Creighton University Medical Center, Omaha, NE, USA.
Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, Colorado, USA.

Background and Objectives:

ERCP is the first line of treatment for benign and malignant biliary obstruction and EUS-guided biliary drainage (EUS-BD) is usually used for patients who have failed ERCP. Recently, several studies have evaluated the role of EUS-BD in the management of benign biliary obstruction. This meta-analysis evaluates the efficacy and safety of EUS-BD in the management of benign biliary obstruction.

Methods:

We reviewed several databases from inception to July 8, 2022, to identify studies evaluating the efficacy and safety of EUS-BD in the management of benign biliary obstruction. Our outcomes of interest were technical success, clinical success, and adverse events. Pooled rates with 95% confidence intervals (CIs) for all outcomes were calculated using a random effects model. Subgroup analyses were performed including patients with normal anatomy versus surgically altered anatomy (SAA). Heterogeneity was assessed by I² statistic.

Results:

We included 14 studies with 329 patients. The pooled rate (95% CI) of technical success was 88% (83%, 92%). The pooled rate (95% CI) of technical success for patients with SAA and normal anatomy was 92% (85%, 96%) and 83% (75%, 89%), respectively. The pooled rates (95% CI) of clinical success and adverse events were 89% (83%, 93%) and 19% (13%, 26%), respectively. We found low heterogeneity in most of the analyses.

Conclusions:

EUS-BD is an effective and safe option in patients with benign biliary obstruction and should be considered after a failed attempt at ERCP or when ERCP is not technically possible.

中文翻译：

EUS引导下胆道引流治疗良性胆道梗阻的有效性和安全性——系统评价和荟萃分析

背景和目标：

ERCP 是良性和恶性胆道梗阻的一线治疗方法，EUS 引导下胆道引流 (EUS-BD) 通常用于 ERCP 失败的患者。最近，一些研究评估了 EUS-BD 在良性胆道梗阻治疗中的作用。该荟萃分析评估了 EUS-BD 在良性胆道梗阻治疗中的有效性和安全性。

方法：

我们回顾了从成立到 2022 年 7 月 8 日的多个数据库，以确定评估 EUS-BD 在良性胆道梗阻治疗中的有效性和安全性的研究。我们感兴趣的结果是技术成功、临床成功和不良事件。使用随机效应模型计算所有结果的具有 95% 置信区间 (CI) 的汇总率。进行亚组分析，包括具有正常解剖结构的患者与手术改变解剖结构（SAA）的患者。通过I ²统计量评估异质性。

结果：

我们纳入了 14 项研究，涉及 329 名患者。技术成功的汇总率 (95% CI) 为 88% (83%, 92%)。SAA 和正常解剖结构患者的技术成功率 (95% CI) 分别为 92% (85%, 96%) 和 83% (75%, 89%)。临床成功率和不良事件的汇总率 (95% CI) 分别为 89% (83%, 93%) 和 19% (13%, 26%)。我们发现大多数分析的异质性较低。