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Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed endoscopic retrograde cholangiopancreatography: a meta-analysis

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ABSTRACT

The failure rate of endoscopic retrograde cholangiopancreatography for biliary cannulation is approximately 6%–7% in cases of obstructive jaundice. Percutaneous transhepatic biliary drainage (PTBD) is the procedure of choice in such cases. Endoscopic ultrasound-guided biliary drainage (EGBD) is a novel technique that allows biliary drainage by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract. Information in PubMed, Scopus, clinicaltrials.gov and Cochrane review were analyzed to obtain studies comparing EGBD and PTBD. Six studies fulfilled the inclusion criteria. Technical (odds ratio (OR): 0.34; confidence interval (CI) 0.10–1.14; p=0.05) and clinical (OR: 1.48; CI 0.46–4.79; p=0.51) success rates were not statistically significant between the EGBD and PTBD groups. Mild adverse events were nonsignificantly different (OR: 0.36; CI 0.10–1.24; p=0.11) but not the moderate-to-severe adverse events (OR: 0.16; CI 0.08–0.32; p≤0.00001) and total adverse events (OR: 0.34; CI 0.20–0.59; p≤0.0001). EGBD is equally effective but safer than PTBD.

No MeSH data available.


(A) Forest plot of technical success and (B) forest plot of clinical success.Abbreviations: EGBD, endoscopic ultrasound-guided biliary drainage; PTBD, percutaneous transhepatic biliary drainage; M–H, Mantel–Haenszel test.
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f2-ceg-10-067: (A) Forest plot of technical success and (B) forest plot of clinical success.Abbreviations: EGBD, endoscopic ultrasound-guided biliary drainage; PTBD, percutaneous transhepatic biliary drainage; M–H, Mantel–Haenszel test.

Mentions: A total of 312 and 300 patients were analyzed for the technical and clinical success rates. Technical (odds ratio (OR): 0.34; CI 0.10–1.14; p=0.05; Figure 2A) and clinical (OR: 1.48; CI 0.46–4.79; p=0.51; Table 2B) success rates were not statistically significant between the EGBD and PTBD groups (Figure 2). Similarly, there was no significant difference in the mild adverse events profile between the two groups (OR: 0.36; CI 0.10–1.24; p=0.11; Figure 3A). On the contrary, the moderate and severe, and total adverse events were significantly less in the EGBD group (OR: 0.16; CI 0.08–0.32; p≤0.00001 and OR: 0.34; CI 0.20–0.59; p≤0.0001, respectively; Figure 3B). Cost analysis of the procedure was done in two studies.13,15 From both the studies, it was found that EGBD was less costly compared to PTBD (Table 3). The re-intervention rate was also less in the EGBD group for all the three studies reporting it (Table 3C).12,15,16


Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed endoscopic retrograde cholangiopancreatography: a meta-analysis
(A) Forest plot of technical success and (B) forest plot of clinical success.Abbreviations: EGBD, endoscopic ultrasound-guided biliary drainage; PTBD, percutaneous transhepatic biliary drainage; M–H, Mantel–Haenszel test.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5384693&req=5

f2-ceg-10-067: (A) Forest plot of technical success and (B) forest plot of clinical success.Abbreviations: EGBD, endoscopic ultrasound-guided biliary drainage; PTBD, percutaneous transhepatic biliary drainage; M–H, Mantel–Haenszel test.
Mentions: A total of 312 and 300 patients were analyzed for the technical and clinical success rates. Technical (odds ratio (OR): 0.34; CI 0.10–1.14; p=0.05; Figure 2A) and clinical (OR: 1.48; CI 0.46–4.79; p=0.51; Table 2B) success rates were not statistically significant between the EGBD and PTBD groups (Figure 2). Similarly, there was no significant difference in the mild adverse events profile between the two groups (OR: 0.36; CI 0.10–1.24; p=0.11; Figure 3A). On the contrary, the moderate and severe, and total adverse events were significantly less in the EGBD group (OR: 0.16; CI 0.08–0.32; p≤0.00001 and OR: 0.34; CI 0.20–0.59; p≤0.0001, respectively; Figure 3B). Cost analysis of the procedure was done in two studies.13,15 From both the studies, it was found that EGBD was less costly compared to PTBD (Table 3). The re-intervention rate was also less in the EGBD group for all the three studies reporting it (Table 3C).12,15,16

View Article: PubMed Central - PubMed

ABSTRACT

The failure rate of endoscopic retrograde cholangiopancreatography for biliary cannulation is approximately 6%–7% in cases of obstructive jaundice. Percutaneous transhepatic biliary drainage (PTBD) is the procedure of choice in such cases. Endoscopic ultrasound-guided biliary drainage (EGBD) is a novel technique that allows biliary drainage by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract. Information in PubMed, Scopus, clinicaltrials.gov and Cochrane review were analyzed to obtain studies comparing EGBD and PTBD. Six studies fulfilled the inclusion criteria. Technical (odds ratio (OR): 0.34; confidence interval (CI) 0.10–1.14; p=0.05) and clinical (OR: 1.48; CI 0.46–4.79; p=0.51) success rates were not statistically significant between the EGBD and PTBD groups. Mild adverse events were nonsignificantly different (OR: 0.36; CI 0.10–1.24; p=0.11) but not the moderate-to-severe adverse events (OR: 0.16; CI 0.08–0.32; p≤0.00001) and total adverse events (OR: 0.34; CI 0.20–0.59; p≤0.0001). EGBD is equally effective but safer than PTBD.

No MeSH data available.