Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana.
Department of Gastroenterology, Seth GS Medical College and KEM Hospital.
Surg Laparosc Endosc Percutan Tech. 2023 Aug 1;33(4):411-419. doi: 10.1097/SLE.0000000000001192.
Endoscopic retrograde cholangiopancreatography (ERCP) may fail to achieve biliary drainage in 5% to 10% of cases. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous transhepatic biliary drainage (PTBD) are alternative therapeutic options in such cases. The present meta-analysis aimed to compare the efficacy and safety of EUS-BD and PTBD for biliary decompression after failed ERCP.
A comprehensive search of literature from inception to September 2022 was done of 3 databases for studies comparing EUS-BD and PTBD for biliary drainage after failed ERCP. Odds ratios (ORs) with 95% CIs were calculated for all the dichotomous outcomes. Continuous variables were analyzed using mean difference (MD).
A total of 24 studies were included in the final analysis. Technical success was comparable between EUS-BD and PTBD (OR=1.12, 0.67-1.88). EUS-BD was associated with a higher clinical success rate (OR=2.55, 1.63-4.56) and lower odds of adverse events (OR=0.41, 0.29-0.59) compared with PTBD. The incidence of major adverse events (OR=0.66, 0.31-1.42) and procedure-related mortality (OR=0.43, 0.17-1.11) were similar between the groups. EUS-BD was associated with lower odds of reintervention with an OR of 0.20 (0.10-0.38). The duration of hospitalization (MD: -4.89, -7.73 to -2.05) and total treatment cost (MD: -1355.46, -2029.75 to -681.17) were significantly lower with EUS-BD.
EUS-BD may be preferred over PTBD in patients with biliary obstruction after failed ERCP where appropriate expertise is available. Further trials are required to validate the findings of the study.
内镜逆行胰胆管造影术（ERCP）在 5%至 10%的病例中可能无法实现胆道引流。在这种情况下，超声内镜引导下胆道引流（EUS-BD）和经皮经肝胆道引流（PTBD）是替代治疗选择。本荟萃分析旨在比较 EUS-BD 和 PTBD 在 ERCP 失败后胆道减压的疗效和安全性。
从 3 个数据库全面检索了从开始到 2022 年 9 月比较 ERCP 失败后 EUS-BD 和 PTBD 胆道引流的文献。对所有二分类结局计算了优势比（OR）和 95%置信区间。连续变量采用均数差（MD）进行分析。
最终分析共纳入 24 项研究。EUS-BD 和 PTBD 的技术成功率相当（OR=1.12，0.67-1.88）。与 PTBD 相比，EUS-BD 与更高的临床成功率（OR=2.55，1.63-4.56）和更低的不良事件发生几率（OR=0.41，0.29-0.59）相关。两组之间主要不良事件（OR=0.66，0.31-1.42）和与操作相关的死亡率（OR=0.43，0.17-1.11）的发生率相似。EUS-BD 与较低的再次介入几率相关，OR 为 0.20（0.10-0.38）。EUS-BD 的住院时间（MD：-4.89，-7.73 至-2.05）和总治疗费用（MD：-1355.46，-2029.75 至-681.17）均显著降低。
在适当的专业知识条件下，EUS-BD 可能优于 PTBD，适用于 ERCP 失败后的胆道梗阻患者。需要进一步的试验来验证研究结果。
