Abdellah Hedjoudje
University hospital of Besancon, France
Title: Outcomes of endoscopic ultrasound-guided biliary drainage: an updated meta-analysis
Biography
Biography: Abdellah Hedjoudje
Abstract
Introduction: Success and event rates of EUS-guided biliary drainage (EUBD) vary with techniques and results from different studies remain inconsistent. We conducted a proportion meta-analysis to evaluate efficacy and safety of EUBD and compare outcomes of current procedures and biliary access routes.
Methods: We searched MEDLINE, EMBASE, COCHRANE and SCOPUS to identify studies reporting technical success, clinical success and complication rate of EUBD techniques with a sample size greater than 10 patients. Weighted pooled rate and 95 % confident interval were calculated to estimate clinical effectiveness and safety of EUBD procedures.
Results: We identified 39 studies including a total of 1640 patients. The overall technical success, per-protocol clinical success and complications rates with 95 % confidence interval were 89% [86 %-92 %], 92% [90 %-94 %] and 20 % (16-24%), respectively. When comparing choledochoduodenostomy with hepaticogastrostomy the pooled 95% CI OR for was 0.78 [0.41; 1.50] (p = 0.462) for technical success and 0.85 [0.51-1.42] (p-val = 0.536) for clinical success. However, pooled OR was 0.65 IC 95% [0.42-0.99] (p-val = 0.047) for complication rate suggesting that EUS-guided choledochoduodenostomy is safer than hepaticogastrostomy. The pooled OR when using the extra-hepatic approach was 1.03 [0.65-1.61] and 0.94 [0.56-1.57] (p-val = 0.804) for technical and clinical success rate respectively. Pooled odds-ratio for adverse events was 0.81 [0.58-1.14] (p-val = 0.221) when using the extra-hepatic approach. Regarding transpapillary technique including Rendezvous and anterograde stenting, technical success, clinical success and adverse event rate were 77% IC 95[71-82], 92% IC95% [83-96%] and 19% IC95%[15%-25%] respectively.
Conclusion: EUS-guided biliary drainage appears to be an effective treatment when ERCP fails with a high success rate and an acceptable adverse event rate. The available literature suggests choledochoduodenosomy to be a safer approach compared to hepaticogastrostomy. Transluminal approaches demonstrate a higher efficacy than transpapillary technique with a similar safety. Randomized controlled trials with sufficiently large cohorts are needed to compare techniques and confirm these findings.