Is ERCP-BD or EUS-BD the preferred decompression modality for malignant distal biliary obstruction?: A meta-analysis of randomized controlled trials

• De-Feng Li ^[1] ; Chun-Hua Zhou ^[2] ; Jun Yao ^[1] ; Duo-Wu Zou ^[3] ; Li-Sheng Wang ^[1]
  1. [1] Jinan University

     Jinan University

     China

     
  2. [2] Soochow University

     Soochow University

     China

     
  3. [3] Shanghai Jiao Tong University

     Shanghai Jiao Tong University

     China

     

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• Localización: Revista Española de Enfermedades Digestivas, ISSN-e 2340-4167, ISSN 1130-0108, Vol. 111, Nº. 12, 2019, págs. 953-960
• Idioma: inglés
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  • Background: endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary drainage (ERCP-BD) with transpapillary stent placement is the standard palliative treatment for malignant distal biliary obstruction. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been evaluated for efficacy and safety as an alternative for failed ERCP. Purpose: we aimed to determine whether ERCP-BD or EUS-BD is the preferred treatment modality for decompressing malignant distal biliary obstruction. Methods: we systematically searched for relevant published, prospective, and randomized trials comparing ERCP-BD with EUS-BD in decompressing malignant distal biliary obstruction in databases (i.e., PubMed and Cochrane). Technical success, treatment success, and procedure duration were primary outcome measurements; overall adverse events, post-ERCP pancreatitis (PEP), and stent reintervention rate were the secondary outcomes. Results: three trials with 220 patients met the inclusion criteria. Technical success, treatment success, procedure duration, and overall adverse event rate were similar between ERCP-BD and EUS-BD. However, ERCP-BD had a significantly higher PEP rate than EUS-BD (9.2% vs. 0%), the difference being significant (risk ratio [RR] = 8.5; 95% confidence interval (CI): 1.03-69.91, p = 0.05). Similarly, ERCP-BD had a higher stent reintervention rate than EUS-BD (28.4% vs. 4.5%), although the difference was not significant (RR = 1.91; 95% CI: 0.94-3.88, p = 0.07). Conclusion: technical success, treatment success, procedure duration, and overall adverse event rate were comparable between ERCP-BD and EUS-BD in decompressing malignant distal biliary obstruction. Nevertheless, EUS-BD had a significantly lower rate of PEP and a lower tendency toward stent reintervention than ERCP-BD. Therefore, EUS-BD might be a suitable alternative to ERCP-BD when performed by experts.