Abstract
Background and Aims
Variable success and adverse event rates have been reported for endoscopic ultrasound-guided biliary drainage (EUS-BD) utilizing either extrahepatic or intrahepatic approach. We aimed to conduct a proportion meta-analysis to evaluate the cumulative efficacy and safety of EUS-BD and to compare the two approaches and transluminal methods of EUS-BD.
Methods
We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ISI Web of Science, and Scopus from January 2001 through January 5, 2015, to identify studies reporting technical success and adverse events of EUS-BD. A sample size of more than 20 patients was a further criterion. Weighted pooled rate (WPR) for technical success and post-procedure complications was calculated for overall studies and predefined subgroups. Pooled odds ratios were calculated for technical success and adverse events for two approaches and transluminal methods of EUS-BD for distal common bile duct (CBD) strictures.
Results
The WPR with 95 % confidence interval (CI) for technical success and post-procedure adverse events was 90 % (86, 93 %) and 17 % (13, 22 %), respectively, with considerable heterogeneity (I 2 = 77 %). For high-quality studies, the WPR for technical success was 94 % (91, 96 %), I 2 = 0 % and WPR for post-procedure adverse event was 16 % (12, 19 %), I 2 = 39 %. In meta-regression model, distal CBD stricture and transpapillary drainage were associated with higher technical success and intrahepatic access route was associated with higher adverse event rate. There was no difference in technical success using either approach OR 1.27 (0.52, 3.13), I 2 = 0 % or transluminal method OR 1.32 (0.51, 3.38), I 2 = 0 %. However, the extrahepatic approach appeared significantly safer as compared to the intrahepatic approach OR 0.35 (0.19, 0.67), I 2 = 27 %. Likewise, choledochoduodenostomy was found to have less adverse events as compared to hepaticogastrostomy, OR 0.40 (0.18, 0.87), I 2 = 0 %.
Conclusion
In cases of failure of traditional ERC to achieve biliary drainage, EUS-BD appears to be an emerging therapeutic modality with a cumulative success rate of 90 % and cumulative adverse events rate of 17 %. Randomized controlled trials are required to further evaluate the efficacy and safety of the procedure along with the comparison to traditional modalities like percutaneous transhepatic biliary drainage.
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Acknowledgments
We are grateful to Dr. Michel Kahaleh, Dr. Juan Vila, Dr. Amol Bapaye, Dr. Frank Weilert, and Dr. Vinay Dhir for providing information and unpublished data from their studies. We thank Dr. Colin W. Howden for his critical review of the manuscript.
Author contribution
Muhammad Ali Khan was involved in conception and design; analyzed and interpreted the data; drafted and finally approved the article, Ali Akbar was involved in conception and design; analyzed the data; finally approved the article, Todd H Baron was involved in conception and design; drafting of article; critical revision for intellectual content and final approval of article, Sobia Khan contributed to statistical analysis, Mehmat Kocak contributed to statistical analysis and finally approved the article, Yaseen Alastal was involved in data collection; analyzed; and finally approved the article, Tariq Hammad was involved in data collection and finally approved the article, Wade M Lee was involved in search strategy and data collection, Aijaz Sofi contributed to statistical analysis, Everson L. A. Artifon and Ali Nawras was involved in critical revision for intellectual content and final approval of article, Mohammad Kashif Ismail contributed to conception and design; analysis and interpretation of data; drafting of article; critical revision; and final approval of article.
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Dr. Todd H Baron (T.H.B) is a consultant for Xlumena, ConMed, WL Gore, BSCI, Cook, Olympus and receive honoraria for speaking from all of them, he does not have stock or receive royalties from any of the companies. Dr. Everson L A Artifon (E.L.A) Artifon is a speaker for mediglobe. He does not have stocks or receive royalty from the company. None of the other authors have any financial disclosures or conflicts of interest to declare.
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Khan, M.A., Akbar, A., Baron, T.H. et al. Endoscopic Ultrasound-Guided Biliary Drainage: A Systematic Review and Meta-Analysis. Dig Dis Sci 61, 684–703 (2016). https://doi.org/10.1007/s10620-015-3933-0
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DOI: https://doi.org/10.1007/s10620-015-3933-0