内镜超声引导下胆道引流中胆总管十二指肠吻合术与肝胃吻合术的比较：一项荟萃分析

Comparison of Choledochoduodenostomy and Hepaticogastrostomy for EUS-Guided Biliary Drainage: A Meta-Analysis.

作者信息

Li Jiasu, Tang Jian, Liu Feng, Fang Jun

机构信息

Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China.

Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.

出版信息

Front Surg. 2022 Mar 10;9:811005. doi: 10.3389/fsurg.2022.811005. eCollection 2022.

BACKGROUND

Although endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) or hepaticogastrostomy (EUS-HGS) has emerged as an option for patients of failed endoscopic retrograde cholangiopancreatography (ERCP), there has no agreement on which approach is preferred. Therefore, a meta-analysis was performed to examine the two methods.

METHODS

We performed a comprehensive search in databases of PubMed, Embase, and Cochrane library to find relevant studies reporting the efficacy and safety of the two EUS-guided biliary drainage methods.

RESULTS

In total, 12 studies with 623 patients (EUS-CDS: 303 and EUS-HGS: 320) were included. The cumulative technical success and clinical success for EUS-CDS and EUS-HGS was 95.0% (288/303), 93.1% (268/288), and 96.6% (309/320), 91.3% (282/309), respectively. Compared with EUS-HGS, the pooled odds ratio (OR) was 0.74 (95% CI 0.33-1.65; = 0.46) for EUS-CDS technical success and 0.94 (95% CI 0.56-1.59; = 0.83) for clinical success. The pooled difference in means of procedure time of EUS-CDS and EUS-HGS was -2.68 (95% CI -5.12 to -0.24; = 0.03). The cumulative early adverse events for EUS-CDS and EUS-HGS was 12.2% (37/303) and 17.5% (56/320), respectively. Compared with EUS-HGS, the pooled OR of early adverse events for EUS-CDS was 0.58 (95% CI: 0.36-0.93; = 0.02).

CONCLUSION

This meta-analysis further suggests EUS-CDS and EUS-HGS have equal high technical and clinical success, but EUS-CDS with a slightly short procedure time and with less early adverse events compared to EUS-HGS.

背景

尽管内镜超声引导下胆总管十二指肠吻合术（EUS-CDS）或肝胃吻合术（EUS-HGS）已成为内镜逆行胰胆管造影术（ERCP）失败患者的一种选择，但对于哪种方法更优尚无共识。因此，进行了一项荟萃分析以比较这两种方法。

方法

我们在PubMed、Embase和Cochrane图书馆数据库中进行了全面检索，以查找报告两种EUS引导下胆道引流方法有效性和安全性的相关研究。

结果

总共纳入了12项研究，共623例患者（EUS-CDS组303例，EUS-HGS组320例）。EUS-CDS和EUS-HGS的累计技术成功率和临床成功率分别为95.0%（288/303）、93.1%（268/288）和96.6%（309/320）、91.3%（282/309）。与EUS-HGS相比，EUS-CDS技术成功的合并比值比（OR）为0.74（95%CI 0.33-1.65；P = 0.46），临床成功的合并比值比为0.94（95%CI 0.56-1.59；P = 0.83）。EUS-CDS和EUS-HGS手术时间均值的合并差异为-2.68（95%CI -5.12至-0.24；P = 0.03）。EUS-CDS和EUS-HGS的累计早期不良事件发生率分别为12.2%（37/303）和17.5%（56/320）。与EUS-HGS相比，EUS-CDS早期不良事件的合并OR为0.58（95%CI：0.36-0.93；P = 0.02）。