EUS-guided biliary drainage: A systematic review and meta-analysis

Banreet Singh Dhindsa, Harmeet Singh Mashiana, Amaninder Dhaliwal, Babu P. Mohan, Mahendran Jayaraj, Harlan Sayles, Shailender Singh, Gordon Ohning, Ishfaq Bhat, Douglas G. Adler

Research output: Contribution to journalReview article

Abstract

ERCP is the current procedure of choice for patients with jaundice caused by biliary obstruction. EUS-guided biliary drainage (EUS-BD) has emerged as an alternative to ERCP in patients requiring biliary drainage. The aim of the study was to conduct a systematic review and meta-analysis to report the overall efficacy and safety of EUS-BD. We conducted a comprehensive search of several databases including PubMed, EMBASE, Web of Science, Google Scholar, and LILACS databases (earliest inception to June 2018) to identify studies that reported EUS-BD in patients. The primary outcome was to look at the technical and clinical success of the procedure. The secondary analysis focused on calculating the pooled rate of re-interventions and all adverse-events, along with the commonly reported adverse-event subtypes. Twenty-three studies reporting on 1437 patients were identified undergoing 1444 procedures. Majority of the patient population were male (53.86%), with an average age of 67.22 years. The pooled technical success rates and clinical success rates were 91.5% (95% confidence interval [CI]: 87.7-94.2, I[2] = 76.5) and 87% (95% CI: 82.3-90.6, I[2] = 72.4), respectively. The total adverse event rates were 17.9% (95% CI: 14.3-22.2, I[2] = 69.1). Subgroup analysis of three major individual adverse events was bile leak: 4.1% (2.7-6.2, I[2] = 46.7), stent migration: 3.9% (2.5-6.2, I[2] = 43.5), and infection: 3.8% (2.8-5.1, I[2] = 0) Substantial heterogeneity was noted in the analysis. EUS-BD has high technical and clinical success rate and hence a very effective procedure. Concerns about publication bias exist. Careful consideration should be given to the adverse events and weighing the risks and benefits of the alternative nonsurgical/surgical approaches.

Original languageEnglish (US)
Pages (from-to)101-109
Number of pages9
JournalEndoscopic Ultrasound
Volume9
Issue number2
DOIs
StatePublished - Mar 1 2020

Keywords

  • Biliary drainage
  • Biliary obstruction
  • ERCP
  • EUS guided
  • jaundice

ASJC Scopus subject areas

  • Hepatology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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  • Cite this

    Dhindsa, B. S., Mashiana, H. S., Dhaliwal, A., Mohan, B. P., Jayaraj, M., Sayles, H., Singh, S., Ohning, G., Bhat, I., & Adler, D. G. (2020). EUS-guided biliary drainage: A systematic review and meta-analysis. Endoscopic Ultrasound, 9(2), 101-109. https://doi.org/10.4103/eus.eus_80_19