Department of Gastroenterology, Shenzhen People's Hospital, China.
the Second Affiliated Hospital of Soochow University.
Rev Esp Enferm Dig. 2019 Dec;111(12):953-960. doi: 10.17235/reed.2019.6125/2018.
endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary drainage (ERCP-BD) with transpapillary stent placement is the standard palliative treatment for malignant distal biliary obstruction. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been evaluated for efficacy and safety as an alternative for failed ERCP.
we aimed to determine whether ERCP-BD or EUS-BD is the preferred treatment modality for decompressing malignant distal biliary obstruction.
we systematically searched for relevant published, prospective, and randomized trials comparing ERCP-BD with EUS-BD in decompressing malignant distal biliary obstruction in databases (i.e., PubMed and Cochrane). Technical success, treatment success, and procedure duration were primary outcome measurements; overall adverse events, post-ERCP pancreatitis (PEP), and stent reintervention rate were the secondary outcomes.
three trials with 220 patients met the inclusion criteria. Technical success, treatment success, procedure duration, and overall adverse event rate were similar between ERCP-BD and EUS-BD. However, ERCP-BD had a significantly higher PEP rate than EUS-BD (9.2% vs. 0%), the difference being significant (risk ratio [RR] = 8.5; 95% confidence interval (CI): 1.03-69.91, p = 0.05). Similarly, ERCP-BD had a higher stent reintervention rate than EUS-BD (28.4% vs. 4.5%), although the difference was not significant (RR = 1.91; 95% CI: 0.94-3.88, p = 0.07).
technical success, treatment success, procedure duration, and overall adverse event rate were comparable between ERCP-BD and EUS-BD in decompressing malignant distal biliary obstruction. Nevertheless, EUS-BD had a significantly lower rate of PEP and a lower tendency toward stent reintervention than ERCP-BD. Therefore, EUS-BD might be a suitable alternative to ERCP-BD when performed by experts.
内镜逆行胰胆管造影（ERCP）引导下的胆道引流（ERCP-BD）联合经乳头支架置入术是治疗恶性远端胆道梗阻的标准姑息性治疗方法。内镜超声引导下胆道引流（EUS-BD）已被评估为一种替代 ERCP 失败的有效且安全的方法。
我们旨在确定 ERCP-BD 与 EUS-BD 治疗恶性远端胆道梗阻的哪种方法更具优势。
我们系统地在数据库（即 PubMed 和 Cochrane）中检索了比较 ERCP-BD 与 EUS-BD 治疗恶性远端胆道梗阻的已发表的前瞻性随机试验。主要的结局测量指标包括技术成功率、治疗成功率和操作时间；次要结局测量指标包括总体不良事件、内镜逆行胰胆管造影术后胰腺炎（PEP）和支架再干预率。
符合纳入标准的有 3 项试验共 220 例患者。ERCP-BD 与 EUS-BD 的技术成功率、治疗成功率、操作时间和总体不良事件发生率相似。然而，ERCP-BD 的 PEP 发生率明显高于 EUS-BD（9.2% vs. 0%），差异具有统计学意义（风险比 [RR] = 8.5；95%置信区间 [CI]：1.03-69.91，p = 0.05）。同样，ERCP-BD 的支架再干预率也高于 EUS-BD（28.4% vs. 4.5%），尽管差异无统计学意义（RR = 1.91；95%CI：0.94-3.88，p = 0.07）。
在恶性远端胆道梗阻的减压治疗中，ERCP-BD 与 EUS-BD 的技术成功率、治疗成功率、操作时间和总体不良事件发生率相似。然而，EUS-BD 的 PEP 发生率显著低于 ERCP-BD，支架再干预率也有降低的趋势。因此，在专家操作下，EUS-BD 可能是 ERCP-BD 的一种合适替代方法。
