Ricardo S Uemura1, Muhammad Ali Khan2, José P Otoch1, Michel Kahaleh3, Edna F Montero1, Everson L A Artifon1. 1. Department of Surgery, University of Sao Paulo School of Medicine, São Paulo-SP, Brazil. 2. Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, TN. 3. Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, NY.
Abstract
BACKGROUND AND AIMS: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative in cases of endoscopic retrograde cholangiopancreatography (ERCP) failure. Two types of EUS-BD methods for achieving biliary drainage when ERCP fails are choledochoduodenostomy (CDS) or hepaticogastrostomy (HGS). However, there is no consensus if one approach is better than the other. Therefore, we conducted a systematic review and meta-analysis to evaluate these 2 main EUS-BD methods. METHODS: We searched MEDLINE, Embase, Scopus, Cochrane database, LILACS from inception through April 8, 2017, using the following search terms in various combinations: biliary drainage, biliary stent, transluminal biliary drainage, choledochoduodenostomy, hepaticogastrostomy, endoscopic ultrasound-guided biliary drainage. We selected studies comparing CDS and HGS in patients with malignant biliary obstruction with ERCP failure. Pooled odds ratio (OR) were calculated for technical success, clinical success, and adverse events and difference of means calculated for duration of procedure and survival after procedure. RESULTS: A total of 10 studies with 434 patients were included in the meta-analysis: 208 underwent biliary drainage via HGS and the remaining 226 via CDS. The technical success for CDS and HGS was 94.1% and 93.7%, respectively, pooled OR=0.96 [95% confidence interval (CI)=0.39-2.33, I=0%]. Clinical success was 88.5% in CDS and 84.5% in HGS, pooled OR=0.76 (95% CI=0.42-1.35, I=17%). There was no difference for adverse events OR=0.97 (95% CI=0.60-1.56), I=37%. CDS was about 2 minutes faster with a pooled difference in means of was -2.69 (95% CI=-4.44 to -0.95). CONCLUSION: EUS-CDS and EUS-HGS have equal efficacy and safety, and are both associated with a very high technical and clinical success. The choice of approach may be selected based on patient anatomy.
BACKGROUND AND AIMS: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative in cases of endoscopic retrograde cholangiopancreatography (ERCP) failure. Two types of EUS-BD methods for achieving biliary drainage when ERCP fails are choledochoduodenostomy (CDS) or hepaticogastrostomy (HGS). However, there is no consensus if one approach is better than the other. Therefore, we conducted a systematic review and meta-analysis to evaluate these 2 main EUS-BD methods. METHODS: We searched MEDLINE, Embase, Scopus, Cochrane database, LILACS from inception through April 8, 2017, using the following search terms in various combinations: biliary drainage, biliary stent, transluminal biliary drainage, choledochoduodenostomy, hepaticogastrostomy, endoscopic ultrasound-guided biliary drainage. We selected studies comparing CDS and HGS in patients with malignant biliary obstruction with ERCP failure. Pooled odds ratio (OR) were calculated for technical success, clinical success, and adverse events and difference of means calculated for duration of procedure and survival after procedure. RESULTS: A total of 10 studies with 434 patients were included in the meta-analysis: 208 underwent biliary drainage via HGS and the remaining 226 via CDS. The technical success for CDS and HGS was 94.1% and 93.7%, respectively, pooled OR=0.96 [95% confidence interval (CI)=0.39-2.33, I=0%]. Clinical success was 88.5% in CDS and 84.5% in HGS, pooled OR=0.76 (95% CI=0.42-1.35, I=17%). There was no difference for adverse events OR=0.97 (95% CI=0.60-1.56), I=37%. CDS was about 2 minutes faster with a pooled difference in means of was -2.69 (95% CI=-4.44 to -0.95). CONCLUSION: EUS-CDS and EUS-HGS have equal efficacy and safety, and are both associated with a very high technical and clinical success. The choice of approach may be selected based on patient anatomy.
Authors: A Hedjoudje; A Sportes; S Grabar; A Zhang; S Koch; L Vuitton; F Prat Journal: United European Gastroenterol J Date: 2018-10-26 Impact factor: 4.623
Authors: Nuno Nunes; Margarida Flor de Lima; Ana Caldeira; Sílvia Leite; Susana Marques; Teresa Moreira; Pedro Moutinho-Ribeiro; Miguel Bispo Journal: GE Port J Gastroenterol Date: 2020-09-25
Authors: Jintao Guo; Marc Giovannini; Anand V Sahai; Adrian Saftoiu; Christoph F Dietrich; Erwin Santo; Pietro Fusaroli; Ali A Siddiqui; Manoop S Bhutani; Anthony Yuen Bun Teoh; Atsushi Irisawa; Brenda Lucia Arturo Arias; Chalapathi Rao Achanta; Christian Jenssen; Dong-Wan Seo; Douglas G Adler; Evangelos Kalaitzakis; Everson Artifon; Fumihide Itokawa; Jan Werner Poley; Girish Mishra; Khek Yu Ho; Hsiu-Po Wang; Hussein Hassan Okasha; Jesse Lachter; Juan J Vila; Julio Iglesias-Garcia; Kenji Yamao; Kenjiro Yasuda; Kensuke Kubota; Laurent Palazzo; Luis Carlos Sabbagh; Malay Sharma; Mitsuhiro Kida; Mohamed El-Nady; Nam Q Nguyen; Peter Vilmann; Pramod Kumar Garg; Praveer Rai; Shuntaro Mukai; Silvia Carrara; Sreeram Parupudi; Subbaramiah Sridhar; Sundeep Lakhtakia; Surinder S Rana; Takeshi Ogura; Todd H Baron; Vinay Dhir; Siyu Sun Journal: Endosc Ultrasound Date: 2018 Nov-Dec Impact factor: 5.628