Ginnaram Shravya Reddy, Nugooru Sudeep, Tahir Dawood, Devine Kara, Shaikh Ali Raza, Yarra Pradeep, Walter James
Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA (Shravya Reddy Ginnaram, Sudeep Nugooru, Dawood Tahir, Kara Devine).
Department of Hematology/Oncology, Thomas Jefferson University Hospital, Philadelphia, PA (Ali Raza Shaikh).
Ann Gastroenterol. 2024 Sep-Oct;37(5):602-609. doi: 10.20524/aog.2024.0912. Epub 2024 Aug 19.
Malignant distal biliary obstruction (MDBO) is a challenging clinical condition commonly managed with endoscopic retrograde cholangiopancreatography (ERCP). However, endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative, especially in complex cases where ERCP fails or is deemed risky. This study aimed to compare the efficacy, safety and cost-effectiveness of EUS-BD vs. ERCP in the palliation of MDBO.
We conducted a systematic review and meta-analysis, following PRISMA guidelines. Three databases were searched up to December 2023, including MEDLINE/PubMed, OVID and the Cochrane Central Register of Controlled Trials, for studies comparing EUS-BD with ERCP. Primary outcomes were technical and clinical success rates, while secondary outcomes included procedural times, hospital stay duration, 30-day mortality, reintervention rates, and adverse events such as pancreatitis.
Seven studies involving 1245 patients met the inclusion criteria. The meta-analysis revealed that EUS-BD had a technical success rate of 92%, compared to 85% for ERCP. Clinical success rates were similar for both EUS-BD and ERCP, at approximately 89%. EUS-BD was associated with a significantly lower incidence of pancreatitis (2% vs. 10% for ERCP).
EUS-BD offers a viable and potentially superior alternative to ERCP for the primary palliation of MDBO, particularly in terms of technical success and a lower risk of pancreatitis. These findings support the adoption of EUS-BD in clinical settings equipped to perform this technique, though future research should focus on long-term outcomes and further economic analysis to solidify these recommendations.
恶性远端胆管梗阻（MDBO）是一种具有挑战性的临床病症，通常采用内镜逆行胰胆管造影术（ERCP）进行治疗。然而，内镜超声引导下胆管引流术（EUS-BD）已成为一种替代方法，尤其是在ERCP失败或被认为有风险的复杂病例中。本研究旨在比较EUS-BD与ERCP在缓解MDBO方面的疗效、安全性和成本效益。
我们按照PRISMA指南进行了系统评价和荟萃分析。检索了截至2023年12月的三个数据库，包括MEDLINE/PubMed、OVID和Cochrane对照试验中央登记册，以查找比较EUS-BD与ERCP的研究。主要结局是技术成功率和临床成功率，次要结局包括手术时间、住院时间、30天死亡率、再次干预率以及胰腺炎等不良事件。
七项涉及1245例患者的研究符合纳入标准。荟萃分析显示，EUS-BD的技术成功率为92%，而ERCP为85%。EUS-BD和ERCP的临床成功率相似，约为89%。EUS-BD与胰腺炎的发生率显著较低相关（分别为2%和10%）。
对于MDBO的初始姑息治疗，EUS-BD是一种可行且可能更优的替代ERCP的方法，特别是在技术成功率和胰腺炎风险较低方面。这些发现支持在有能力开展该技术的临床环境中采用EUS-BD，不过未来的研究应侧重于长期结局和进一步的经济分析，以巩固这些建议。
