Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials
Background/Aims Malignant biliary obstruction is a major clinical challenge. We assessed the efficacy of endoscopic ultrasound-guided biliary drainage (EUS-BD) compared with that of endoscopic retrograde cholangiopancreatography biliary drainage (ERCP-BD) or percutaneous transhepatic biliary drainag...
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| Format: | Article |
| Language: | English |
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Korean Society of Gastrointestinal Endoscopy
2025-07-01
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| Series: | Clinical Endoscopy |
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| Online Access: | http://e-ce.org/upload/pdf/ce-2024-183.pdf |
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| author | Yousaf Zafar Hafsa Azam Muhammad Abdullah Bin Azhar Fabeeha Shaheen Syed Sarmad Javaid Laila Manzoor Muaaz Masood Rajesh Krishnamoorthi |
| author_facet | Yousaf Zafar Hafsa Azam Muhammad Abdullah Bin Azhar Fabeeha Shaheen Syed Sarmad Javaid Laila Manzoor Muaaz Masood Rajesh Krishnamoorthi |
| author_sort | Yousaf Zafar |
| collection | DOAJ |
| description | Background/Aims Malignant biliary obstruction is a major clinical challenge. We assessed the efficacy of endoscopic ultrasound-guided biliary drainage (EUS-BD) compared with that of endoscopic retrograde cholangiopancreatography biliary drainage (ERCP-BD) or percutaneous transhepatic biliary drainage (PTBD). Methods We searched for randomized controlled trials comparing EUS-BD with ERCP or PTBD in treating malignant biliary obstruction. Using random-effects models, we synthesized risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs). A subgroup analysis was performed using a comparator (ERCP or PTBD). Results EUS-BD significantly reduced the risk of stent dysfunction (RR, 0.46; 95% CI, 0.33–0.64), with consistent results in subgroup analysis for ERCP (RR, 0.54; 95% CI, 0.35–0.84) and PTBD (RR, 0.37; 95% CI, 0.22–0.61). It also lowered the risk of post-procedure pancreatitis (RR, 0.24; 95% CI, 0.07–0.83) and reduced tumor ingrowth or overgrowth risk (RR, 0.27; 95% CI, 0.11–0.65), even when compared to ERCP alone (RR, 0.28; 95% CI, 0.11–0.70). EUS-BD demonstrated a lower risk of adverse events compared to PTBD (RR, 0.37; 95% CI, 0.14–0.97) and reduced length of hospital stay (WMD, –1.03; 95% CI, –1.53 to –0.53) when compared to ERCP. Conclusions EUS-BD outperformed ERCP-BD and PTBD in reducing stent dysfunction, postprocedural pancreatitis, and tumor ingrowth or overgrowth. |
| format | Article |
| id | doaj-art-b498bd6aa0864f14b944ad9ef33ff9bc |
| institution | DOAJ |
| issn | 2234-2400 2234-2443 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Korean Society of Gastrointestinal Endoscopy |
| record_format | Article |
| series | Clinical Endoscopy |
| spelling | doaj-art-b498bd6aa0864f14b944ad9ef33ff9bc2025-08-20T03:16:21ZengKorean Society of Gastrointestinal EndoscopyClinical Endoscopy2234-24002234-24432025-07-0158453354310.5946/ce.2024.1837963Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trialsYousaf Zafar0Hafsa Azam1Muhammad Abdullah Bin Azhar2Fabeeha Shaheen3Syed Sarmad Javaid4Laila Manzoor5Muaaz Masood6Rajesh Krishnamoorthi7 Department of Medicine, The University of Mississippi Medical Center, Jackson, MS, USA Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan Department of Medicine, The University of Mississippi Medical Center, Jackson, MS, USA Division of Gastroenterology and Hepatology, Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA, USA Division of Gastroenterology and Hepatology, Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA, USABackground/Aims Malignant biliary obstruction is a major clinical challenge. We assessed the efficacy of endoscopic ultrasound-guided biliary drainage (EUS-BD) compared with that of endoscopic retrograde cholangiopancreatography biliary drainage (ERCP-BD) or percutaneous transhepatic biliary drainage (PTBD). Methods We searched for randomized controlled trials comparing EUS-BD with ERCP or PTBD in treating malignant biliary obstruction. Using random-effects models, we synthesized risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs). A subgroup analysis was performed using a comparator (ERCP or PTBD). Results EUS-BD significantly reduced the risk of stent dysfunction (RR, 0.46; 95% CI, 0.33–0.64), with consistent results in subgroup analysis for ERCP (RR, 0.54; 95% CI, 0.35–0.84) and PTBD (RR, 0.37; 95% CI, 0.22–0.61). It also lowered the risk of post-procedure pancreatitis (RR, 0.24; 95% CI, 0.07–0.83) and reduced tumor ingrowth or overgrowth risk (RR, 0.27; 95% CI, 0.11–0.65), even when compared to ERCP alone (RR, 0.28; 95% CI, 0.11–0.70). EUS-BD demonstrated a lower risk of adverse events compared to PTBD (RR, 0.37; 95% CI, 0.14–0.97) and reduced length of hospital stay (WMD, –1.03; 95% CI, –1.53 to –0.53) when compared to ERCP. Conclusions EUS-BD outperformed ERCP-BD and PTBD in reducing stent dysfunction, postprocedural pancreatitis, and tumor ingrowth or overgrowth.http://e-ce.org/upload/pdf/ce-2024-183.pdfbiliary tract diseasesendoscopic retrograde cholangiopancreatographyendoscopymeta-analysis |
| spellingShingle | Yousaf Zafar Hafsa Azam Muhammad Abdullah Bin Azhar Fabeeha Shaheen Syed Sarmad Javaid Laila Manzoor Muaaz Masood Rajesh Krishnamoorthi Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials Clinical Endoscopy biliary tract diseases endoscopic retrograde cholangiopancreatography endoscopy meta-analysis |
| title | Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials |
| title_full | Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials |
| title_fullStr | Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials |
| title_full_unstemmed | Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials |
| title_short | Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials |
| title_sort | efficacy of endoscopic ultrasound guided biliary drainage of malignant biliary obstruction a systematic review and meta analysis of randomized controlled trials |
| topic | biliary tract diseases endoscopic retrograde cholangiopancreatography endoscopy meta-analysis |
| url | http://e-ce.org/upload/pdf/ce-2024-183.pdf |
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