Endoscopic Ultrasound-Guided Biliary Drainage

A Systematic Review and Meta-Analysis

Muhammad Ali Khan, Ali Akbar, Todd H. Baron, Sobia Khan, Mehmet Kocak, Yaseen Alastal, Tariq Hammad, Wade M. Lee, Aijaz Sofi, Everson L.A. Artifon, Ali Nawras, Mohammad Ismail

Research output: Contribution to journalReview article

47 Citations (Scopus)

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 (I2 = 77 %). For high-quality studies, the WPR for technical success was 94 % (91, 96 %), I2 = 0 % and WPR for post-procedure adverse event was 16 % (12, 19 %), I2 = 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), I2 = 0 % or transluminal method OR 1.32 (0.51, 3.38), I2 = 0 %. However, the extrahepatic approach appeared significantly safer as compared to the intrahepatic approach OR 0.35 (0.19, 0.67), I2 = 27 %. Likewise, choledochoduodenostomy was found to have less adverse events as compared to hepaticogastrostomy, OR 0.40 (0.18, 0.87), I2 = 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.

Original languageEnglish (US)
Pages (from-to)684-703
Number of pages20
JournalDigestive Diseases and Sciences
Volume61
Issue number3
DOIs
StatePublished - Mar 1 2016

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Meta-Analysis
Drainage
Common Bile Duct
Pathologic Constriction
Choledochostomy
Safety
MEDLINE
Sample Size
Randomized Controlled Trials
Odds Ratio
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Physiology
  • Gastroenterology

Cite this

Endoscopic Ultrasound-Guided Biliary Drainage : A Systematic Review and Meta-Analysis. / Khan, Muhammad Ali; Akbar, Ali; Baron, Todd H.; Khan, Sobia; Kocak, Mehmet; Alastal, Yaseen; Hammad, Tariq; Lee, Wade M.; Sofi, Aijaz; Artifon, Everson L.A.; Nawras, Ali; Ismail, Mohammad.

In: Digestive Diseases and Sciences, Vol. 61, No. 3, 01.03.2016, p. 684-703.

Research output: Contribution to journalReview article

Khan, MA, Akbar, A, Baron, TH, Khan, S, Kocak, M, Alastal, Y, Hammad, T, Lee, WM, Sofi, A, Artifon, ELA, Nawras, A & Ismail, M 2016, 'Endoscopic Ultrasound-Guided Biliary Drainage: A Systematic Review and Meta-Analysis', Digestive Diseases and Sciences, vol. 61, no. 3, pp. 684-703. https://doi.org/10.1007/s10620-015-3933-0
Khan, Muhammad Ali ; Akbar, Ali ; Baron, Todd H. ; Khan, Sobia ; Kocak, Mehmet ; Alastal, Yaseen ; Hammad, Tariq ; Lee, Wade M. ; Sofi, Aijaz ; Artifon, Everson L.A. ; Nawras, Ali ; Ismail, Mohammad. / Endoscopic Ultrasound-Guided Biliary Drainage : A Systematic Review and Meta-Analysis. In: Digestive Diseases and Sciences. 2016 ; Vol. 61, No. 3. pp. 684-703.
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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 (I2 = 77 {\%}). For high-quality studies, the WPR for technical success was 94 {\%} (91, 96 {\%}), I2 = 0 {\%} and WPR for post-procedure adverse event was 16 {\%} (12, 19 {\%}), I2 = 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), I2 = 0 {\%} or transluminal method OR 1.32 (0.51, 3.38), I2 = 0 {\%}. However, the extrahepatic approach appeared significantly safer as compared to the intrahepatic approach OR 0.35 (0.19, 0.67), I2 = 27 {\%}. Likewise, choledochoduodenostomy was found to have less adverse events as compared to hepaticogastrostomy, OR 0.40 (0.18, 0.87), I2 = 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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T1 - Endoscopic Ultrasound-Guided Biliary Drainage

T2 - A Systematic Review and Meta-Analysis

AU - Khan, Muhammad Ali

AU - Akbar, Ali

AU - Baron, Todd H.

AU - Khan, Sobia

AU - Kocak, Mehmet

AU - Alastal, Yaseen

AU - Hammad, Tariq

AU - Lee, Wade M.

AU - Sofi, Aijaz

AU - Artifon, Everson L.A.

AU - Nawras, Ali

AU - Ismail, Mohammad

PY - 2016/3/1

Y1 - 2016/3/1

N2 - 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 (I2 = 77 %). For high-quality studies, the WPR for technical success was 94 % (91, 96 %), I2 = 0 % and WPR for post-procedure adverse event was 16 % (12, 19 %), I2 = 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), I2 = 0 % or transluminal method OR 1.32 (0.51, 3.38), I2 = 0 %. However, the extrahepatic approach appeared significantly safer as compared to the intrahepatic approach OR 0.35 (0.19, 0.67), I2 = 27 %. Likewise, choledochoduodenostomy was found to have less adverse events as compared to hepaticogastrostomy, OR 0.40 (0.18, 0.87), I2 = 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.

AB - 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 (I2 = 77 %). For high-quality studies, the WPR for technical success was 94 % (91, 96 %), I2 = 0 % and WPR for post-procedure adverse event was 16 % (12, 19 %), I2 = 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), I2 = 0 % or transluminal method OR 1.32 (0.51, 3.38), I2 = 0 %. However, the extrahepatic approach appeared significantly safer as compared to the intrahepatic approach OR 0.35 (0.19, 0.67), I2 = 27 %. Likewise, choledochoduodenostomy was found to have less adverse events as compared to hepaticogastrostomy, OR 0.40 (0.18, 0.87), I2 = 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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