Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Dig Endosc. 2020 Jan;32(1):16-26. doi: 10.1111/den.13456. Epub 2019 Jul 6.
Current evidence supporting the utility of endoscopic ultrasound-guided biliary drainage (EUS-BD) as primary treatment for distal malignant biliary obstruction (MBO) is limited. We conducted a meta-analysis to compare the performance of EUS-BD and endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD) as primary palliation of distal MBO.
We searched several databases for comparative studies evaluating EUS-BD vs. ERCP-BD in primary drainage of distal MBO up to 28 February 2019. Primary outcomes were technical success and clinical success. Secondary outcomes included adverse events, stent patency, stent dysfunction, tumor in/overgrowth, reinterventions, procedure duration, and overall survival.
Four studies involving 302 patients were qualified for the final analysis. There was no difference in technical success (risk ratio [RR] 1.00; 95% confidence interval [95% CI] 0.93-1.08), clinical success (RR 1.00; 95% CI 0.94-1.06) and total adverse events (RR 0.68; 95% CI: 0.31-1.48) between the two procedures. EUS-BD was associated with lower rates of post-procedure pancreatitis (RR 0.12; 95% CI 0.02-0.62), stent dysfunction (RR 0.54; 95% CI 0.32-0.91), and tumor in/overgrowth (RR 0.22; 95% CI 0.07-0.76). No differences were noted in reinterventions (RR 0.59; 95% CI 0.21-1.69), procedure duration (weighted mean difference -2.11; 95% CI -9.51 to 5.29), stent patency (hazard ratio [HR] 0.61; 95% CI 0.34-1.11), and overall survival (HR 1.00; 95% CI 0.66-1.51).
With adequate endoscopy expertise, EUS-BD could show similar efficacy and safety when compared with ERCP-BD for primary palliation of distal MBO and exhibits several clinical advantages.
目前支持内镜超声引导下胆道引流(EUS-BD)作为远端恶性胆道梗阻(MBO)的主要治疗方法的证据有限。我们进行了一项荟萃分析,以比较 EUS-BD 和内镜逆行胰胆管造影引导下胆道引流(ERCP-BD)作为远端 MBO 初步姑息治疗的疗效。
我们检索了截至 2019 年 2 月 28 日评估 EUS-BD 与 ERCP-BD 在远端 MBO 初次引流的比较研究的多个数据库。主要结局为技术成功率和临床成功率。次要结局包括不良事件、支架通畅性、支架功能障碍、肿瘤内/过度生长、再次干预、手术时间和总生存。
4 项纳入 302 例患者的研究符合最终分析标准。两种方法的技术成功率(风险比 [RR] 1.00;95%置信区间 [95%CI] 0.93-1.08)、临床成功率(RR 1.00;95%CI 0.94-1.06)和总不良事件发生率(RR 0.68;95%CI:0.31-1.48)均无差异。EUS-BD 与术后胰腺炎(RR 0.12;95%CI 0.02-0.62)、支架功能障碍(RR 0.54;95%CI 0.32-0.91)和肿瘤内/过度生长(RR 0.22;95%CI 0.07-0.76)的发生率较低有关。再次干预(RR 0.59;95%CI 0.21-1.69)、手术时间(加权均数差-2.11;95%CI-9.51 至 5.29)、支架通畅率(HR 0.61;95%CI 0.34-1.11)和总生存(HR 1.00;95%CI 0.66-1.51)无差异。
在内镜专业知识足够的情况下,EUS-BD 与 ERCP-BD 相比,在远端 MBO 的初次姑息治疗中显示出相似的疗效和安全性,并具有一些临床优势。