Efficacy and Safety of Endoscopic Ultrasound-Guided Biliary Drainage: A Systematic Review and Meta-analysis: Presidential Poster

Abstract

Introduction: Endoscopic retrograde cholangiography (ERC) with stent placement is the procedure of choice for relief of biliary obstruction. In 10% cases ERC fails and such patients undergo percutaneous transhepatic biliary drainage (PTBD) or surgical bypass. However, these procedures are associated with substantial morbidity and/or mortality. Endoscopic ultrasound guided biliary drainage (EUS-BD) is a relatively new therapeutic modality for attaining satisfactory biliary drainage when traditional ERC fails. We aimed to conduct a meta-analysis evaluating the cumulative efficacy and safety of EUS-BD.Figure 1Figure 2Figure 3Methods: We searched Medline, EMBASE, Cochrane database, ISI Web of Science and Scopus from January 1, 2001 through March 31, 2015, to identify studies reporting technical success and postprocedure adverse events of EUS-BD. A sample size of more than 20 patients was a further criterion. Weighted pooled rates (WPR) for technical success and post-procedure complications were calculated for overall studies and predefined subgroups based on quality of studies. These were analyzed using the random or fixed effects model for meta-analysis based on heterogeneity. Newcastle Ottawa Scale was used for observational studies and Jadad scale was used for randomized controlled trial to assess quality of studies. Results: A total of 20 studies were included in the analysis to evaluate the efficacy and safety of EUS-BD. The WPR with 95% confidence interval (CI) for technical success and post-procedure adverse events were 90% (86%, 93%) and 17% (13%, 22%) respectively with considerable heterogeneity (I2=77%). For high quality studies, the WPR for technical success was 94% (92%, 96%), with no heterogeneity (I2=0%) and WPR for post-procedure adverse event was 13% (10%, 16%), with low heterogeneity, (I2=39%). Overall, WPR for clinical success was 95% (93%, 97%) with no heterogeneity (I=22%). Conclusion: In the light of our meta-analysis, EUS-BD appears to be a very good alternative option for therapeutic and palliative biliary drainage in cases where ERC fails. Currently the procedure is under evolution and is being conducted at expert endoscopy centers. Consortium meetings are held every year to discuss the progress of EUS-BD. In future randomized control trials are required to further evaluate the efficacy and safety of procedure along with comparison to traditional modalities like PTBD.