Shah Yash, Singh Sahib, Dahiya Dushyant S, Calderon-Martinez Ernesto, Sebastian Sneha A, Gangwani Manesh K, Ahmed Zohaib, Chandan Saurabh, Mohan Babu, Advani Rashmi
Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI.
Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD.
Surg Laparosc Endosc Percutan Tech. 2025 Aug 1;35(4):e1386. doi: 10.1097/SLE.0000000000001386.
Endoscopic retrograde cholangiopancreatography (ERCP) remains the primary treatment for biliary obstruction, yet fails in 5% to 7% of cases, necessitating alternative therapeutic options like endoscopic ultrasound-guided biliary drainage (EUS-BD). With acute cholangitis posing significant morbidity and mortality risks, assessing the safety and efficacy of EUS-BD in these patients is vital. This is the first meta-analysis with a subgroup analysis assessing the outcomes of EUS-BD in patients with acute cholangitis secondary to biliary obstruction.
A systematic review and meta-analysis were conducted following PRISMA guidelines, searching MEDLINE, Embase, Web of Science, Clinicaltrials.gov, and Cochrane databases until December 23, 2023. Studies involving adult patients undergoing EUS-BD for cholangitis were included. Outcomes assessed were pooled technical and clinical success rates, complications, and mortality. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was assessed using the I2 % statistics.
Among the included 5 studies (109 patients), EUS-BD achieved a pooled technical success rate of 95.5% (95% CI: 91.0-98.5) and a clinical success rate of 92.1% (95% CI: 86.4-96.3), with low heterogeneity across studies ( I2 : 0.00% for both outcomes). The pooled complication rate was 12.2% (95% CI: 5.1-21.8, I2 : 37.46%), with predominantly mild and self-limiting complications.
EUS-BD demonstrated excellent pooled technical and clinical success rates, particularly when ERCP is not feasible in patients with acute cholangitis secondary to biliary obstruction. Most postprocedure complication rates are also mild and self-limiting making EUS-BD a possible alternative for the management of patients with cholangitis.
内镜逆行胰胆管造影术（ERCP）仍然是胆管梗阻的主要治疗方法，但在5%至7%的病例中失败，因此需要像内镜超声引导下胆管引流术（EUS-BD）这样的替代治疗选择。由于急性胆管炎具有显著的发病和死亡风险，评估EUS-BD在这些患者中的安全性和有效性至关重要。这是第一项进行亚组分析以评估EUS-BD在继发于胆管梗阻的急性胆管炎患者中治疗效果的荟萃分析。
按照PRISMA指南进行系统评价和荟萃分析，检索MEDLINE、Embase、Web of Science、Clinicaltrials.gov和Cochrane数据库，检索截至2023年12月23日。纳入涉及因胆管炎接受EUS-BD治疗的成年患者的研究。评估的结果包括汇总的技术成功率和临床成功率、并发症及死亡率。采用随机效应模型运用标准荟萃分析方法，并使用I2%统计量评估异质性。
在纳入的5项研究（109例患者）中，EUS-BD的汇总技术成功率为95.5%（95%置信区间：91.0 - 98.5），临床成功率为92.1%（95%置信区间：86.4 - 96.3），各研究间异质性较低（两项结果的I2均为0.00%）。汇总并发症发生率为12.2%（95%置信区间：5.1 - 21.8，I2：37.46%），主要为轻度且自限性并发症。
EUS-BD显示出优异的汇总技术成功率和临床成功率, 尤其是在继发于胆管梗阻的急性胆管炎患者中ERCP不可行时。大多数术后并发症发生率也为轻度且自限性，使EUS-BD成为胆管炎患者治疗的一种可能替代方法。
