Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails

a systematic review and meta-analysis

Reem Z. Sharaiha, Muhammad Ali Khan, Faisal Kamal, Amy Tyberg, Claudio Tombazzi, Bilal Ali, Claudio Tombazzi, Michel Kahaleh

Research output: Contribution to journalReview article

64 Citations (Scopus)

Abstract

Background and Aims EUS-guided biliary drainage (EUS-BD) is increasingly used as an alternate therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction in patients who fail ERCP. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures. Methods We searched several databases from inception to September 4, 2016 to identify comparative studies evaluating the efficacy and safety of EUS-BD and PTBD. Primary outcomes of interest were the differences in technical success and postprocedure adverse events. Secondary outcomes of interest included clinical success, rate of reintervention, length of hospital stay, and cost comparison for these 2 procedures. Odds ratios (ORs) and standard mean difference were calculated for categorical and continuous variables, respectively. These were analyzed using random effects model of meta-analysis. Results Nine studies with 483 patients were included in the final analysis. There was no difference in technical success between 2 procedures (OR, 1.78; 95% CI, .69-4.59; I 2  = 22%) but EUS-BD was associated with better clinical success (OR, .45; 95% CI, .23-.89; I 2  = 0%), fewer postprocedure adverse events (OR, .23; 95% CI, .12-.47; I 2  = 57%), and lower rate of reintervention (OR, .13; 95% CI, .07-.24; I 2  = 0%). There was no difference in length of hospital stay after the procedures, with a pooled standard mean difference of –.48 (95% CI, –1.13 to .16), but EUS-BD was more cost-effective, with a pooled standard mean difference of –.63 (95% CI, –1.06 to –.20). However, the latter 2 analyses were limited by considerable heterogeneity. Conclusions When ERCP fails to achieve biliary drainage, EUS-guided interventions may be preferred over PTBD if adequate advanced endoscopy expertise and logistics are available. EUS-BD is associated with significantly better clinical success, lower rate of postprocedure adverse events, and fewer reinterventions.

Original languageEnglish (US)
Pages (from-to)904-914
Number of pages11
JournalGastrointestinal Endoscopy
Volume85
Issue number5
DOIs
StatePublished - May 1 2017

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Endoscopic Retrograde Cholangiopancreatography
Meta-Analysis
Drainage
Safety
Odds Ratio
Length of Stay
Costs and Cost Analysis
Hospital Costs
Endoscopy
Databases

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails : a systematic review and meta-analysis. / Sharaiha, Reem Z.; Khan, Muhammad Ali; Kamal, Faisal; Tyberg, Amy; Tombazzi, Claudio; Ali, Bilal; Tombazzi, Claudio; Kahaleh, Michel.

In: Gastrointestinal Endoscopy, Vol. 85, No. 5, 01.05.2017, p. 904-914.

Research output: Contribution to journalReview article

Sharaiha, Reem Z. ; Khan, Muhammad Ali ; Kamal, Faisal ; Tyberg, Amy ; Tombazzi, Claudio ; Ali, Bilal ; Tombazzi, Claudio ; Kahaleh, Michel. / Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails : a systematic review and meta-analysis. In: Gastrointestinal Endoscopy. 2017 ; Vol. 85, No. 5. pp. 904-914.
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abstract = "Background and Aims EUS-guided biliary drainage (EUS-BD) is increasingly used as an alternate therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction in patients who fail ERCP. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures. Methods We searched several databases from inception to September 4, 2016 to identify comparative studies evaluating the efficacy and safety of EUS-BD and PTBD. Primary outcomes of interest were the differences in technical success and postprocedure adverse events. Secondary outcomes of interest included clinical success, rate of reintervention, length of hospital stay, and cost comparison for these 2 procedures. Odds ratios (ORs) and standard mean difference were calculated for categorical and continuous variables, respectively. These were analyzed using random effects model of meta-analysis. Results Nine studies with 483 patients were included in the final analysis. There was no difference in technical success between 2 procedures (OR, 1.78; 95{\%} CI, .69-4.59; I 2  = 22{\%}) but EUS-BD was associated with better clinical success (OR, .45; 95{\%} CI, .23-.89; I 2  = 0{\%}), fewer postprocedure adverse events (OR, .23; 95{\%} CI, .12-.47; I 2  = 57{\%}), and lower rate of reintervention (OR, .13; 95{\%} CI, .07-.24; I 2  = 0{\%}). There was no difference in length of hospital stay after the procedures, with a pooled standard mean difference of –.48 (95{\%} CI, –1.13 to .16), but EUS-BD was more cost-effective, with a pooled standard mean difference of –.63 (95{\%} CI, –1.06 to –.20). However, the latter 2 analyses were limited by considerable heterogeneity. Conclusions When ERCP fails to achieve biliary drainage, EUS-guided interventions may be preferred over PTBD if adequate advanced endoscopy expertise and logistics are available. EUS-BD is associated with significantly better clinical success, lower rate of postprocedure adverse events, and fewer reinterventions.",
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T1 - Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails

T2 - a systematic review and meta-analysis

AU - Sharaiha, Reem Z.

AU - Khan, Muhammad Ali

AU - Kamal, Faisal

AU - Tyberg, Amy

AU - Tombazzi, Claudio

AU - Ali, Bilal

AU - Tombazzi, Claudio

AU - Kahaleh, Michel

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background and Aims EUS-guided biliary drainage (EUS-BD) is increasingly used as an alternate therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction in patients who fail ERCP. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures. Methods We searched several databases from inception to September 4, 2016 to identify comparative studies evaluating the efficacy and safety of EUS-BD and PTBD. Primary outcomes of interest were the differences in technical success and postprocedure adverse events. Secondary outcomes of interest included clinical success, rate of reintervention, length of hospital stay, and cost comparison for these 2 procedures. Odds ratios (ORs) and standard mean difference were calculated for categorical and continuous variables, respectively. These were analyzed using random effects model of meta-analysis. Results Nine studies with 483 patients were included in the final analysis. There was no difference in technical success between 2 procedures (OR, 1.78; 95% CI, .69-4.59; I 2  = 22%) but EUS-BD was associated with better clinical success (OR, .45; 95% CI, .23-.89; I 2  = 0%), fewer postprocedure adverse events (OR, .23; 95% CI, .12-.47; I 2  = 57%), and lower rate of reintervention (OR, .13; 95% CI, .07-.24; I 2  = 0%). There was no difference in length of hospital stay after the procedures, with a pooled standard mean difference of –.48 (95% CI, –1.13 to .16), but EUS-BD was more cost-effective, with a pooled standard mean difference of –.63 (95% CI, –1.06 to –.20). However, the latter 2 analyses were limited by considerable heterogeneity. Conclusions When ERCP fails to achieve biliary drainage, EUS-guided interventions may be preferred over PTBD if adequate advanced endoscopy expertise and logistics are available. EUS-BD is associated with significantly better clinical success, lower rate of postprocedure adverse events, and fewer reinterventions.

AB - Background and Aims EUS-guided biliary drainage (EUS-BD) is increasingly used as an alternate therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction in patients who fail ERCP. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures. Methods We searched several databases from inception to September 4, 2016 to identify comparative studies evaluating the efficacy and safety of EUS-BD and PTBD. Primary outcomes of interest were the differences in technical success and postprocedure adverse events. Secondary outcomes of interest included clinical success, rate of reintervention, length of hospital stay, and cost comparison for these 2 procedures. Odds ratios (ORs) and standard mean difference were calculated for categorical and continuous variables, respectively. These were analyzed using random effects model of meta-analysis. Results Nine studies with 483 patients were included in the final analysis. There was no difference in technical success between 2 procedures (OR, 1.78; 95% CI, .69-4.59; I 2  = 22%) but EUS-BD was associated with better clinical success (OR, .45; 95% CI, .23-.89; I 2  = 0%), fewer postprocedure adverse events (OR, .23; 95% CI, .12-.47; I 2  = 57%), and lower rate of reintervention (OR, .13; 95% CI, .07-.24; I 2  = 0%). There was no difference in length of hospital stay after the procedures, with a pooled standard mean difference of –.48 (95% CI, –1.13 to .16), but EUS-BD was more cost-effective, with a pooled standard mean difference of –.63 (95% CI, –1.06 to –.20). However, the latter 2 analyses were limited by considerable heterogeneity. Conclusions When ERCP fails to achieve biliary drainage, EUS-guided interventions may be preferred over PTBD if adequate advanced endoscopy expertise and logistics are available. EUS-BD is associated with significantly better clinical success, lower rate of postprocedure adverse events, and fewer reinterventions.

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