Peppas Spyros, Suvarnakar Advait, Abujaber Bara A, Altork Nadera, Arman Amer, Alzraikat Sayel, Ahmad Akram I, Boustani Camille, Cho Won Kyoo
Department of Medicine, MedStar Washington Hospital Center, Washington, DC, USA.
Department of Internal Medicine, Georgetown University School of Medicine, Washington, DC, USA.
Clin Endosc. 2025 May;58(3):386-397. doi: 10.5946/ce.2024.155. Epub 2025 May 9.
BACKGROUND/AIMS: Evidence suggests comparable outcomes between endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in the biliary drainage of malignant distal biliary obstruction (MDBO). We conducted an updated systematic review and meta-analysis comparing the EUS with ERCP in the management of MDBO.
We performed a literature search using the Medline, Embase and Cochrane databases, including randomized controlled trials comparing EUS and ERCP in patients with MDBO. Meta-analysis was performed using the random-effects model using the STATA ver. 17.0 software.
Both procedures were comparable in technical (risk ratio [RR], 1.01; 95% confidence interval [CI], 0.78-1.30) and clinical (RR, 1.10; 95% CI, 0.85-1.41) success. No difference was identified in total adverse events (RR, 0.75; 95% CI, 0.42-1.35), acute cholangitis (RR, 0.84; 95% CI, 0.43-1.62), stent patency (RR, 1.13; 95% CI, 0.87-1.46) and mean stent patency time (mean difference, -0.01; 95% CI: -0.21 to 0.19). ERCP was associated with a higher risk of procedure-related pancreatitis (RR, 0.17; 95% CI, 0.04-0.68) and statistically non-significant higher risk for reintervention (RR, 0.61; 95% CI, 0.37-1.01).
Although EUS and ERCP were comparable in terms of efficacy and safety, ERCP was associated with a higher risk of procedure-related pancreatitis and reintervention, with the latter finding not reaching statistical significance.
背景/目的：有证据表明，在恶性远端胆管梗阻（MDBO）的胆管引流中，内镜超声（EUS）和内镜逆行胰胆管造影（ERCP）的治疗效果相当。我们进行了一项更新的系统评价和荟萃分析，比较EUS和ERCP在MDBO治疗中的效果。
我们使用Medline、Embase和Cochrane数据库进行文献检索，纳入比较EUS和ERCP治疗MDBO患者的随机对照试验。使用STATA 17.0软件，采用随机效应模型进行荟萃分析。
在技术成功率（风险比[RR]，1.01；95%置信区间[CI]，0.78 - 1.30）和临床成功率（RR，1.10；95% CI，0.85 - 1.41）方面，两种操作相当。在总不良事件（RR，0.75；95% CI，0.42 - 1.35）、急性胆管炎（RR，0.84；95% CI，0.43 - 1.62）、支架通畅率（RR，1.13；95% CI，0.87 - 1.46）和平均支架通畅时间（平均差，-0.01；95% CI：-0.21至0.19）方面未发现差异。ERCP与操作相关胰腺炎的风险较高（RR，0.17；95% CI, 0.04 - 0.68）相关，并且再次干预的风险在统计学上虽无显著差异，但有升高趋势（RR，0.61；95% CI，0.37 - 1.01）。
虽然EUS和ERCP在疗效和安全性方面相当，但ERCP与操作相关胰腺炎和再次干预的风险较高相关，后一项结果未达到统计学显著性。
