BACKGROUND AND AIMS:

Endoscopic ultrasound-guided biliary drainage (EUS-BD) is being increasingly used as an alternate therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction in patients who fail ERCP. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures.

METHODS:

We searched several databases from inception to September 4, 2016, to identify comparative studies evaluating the efficacy and safety of EUS-BD and PTBD. Primary outcomes of interest were the differences in technical success and postprocedure adverse events. Secondary outcomes of interest included clinical success, rate of re-intervention, length of stay in hospital, and cost comparison for these 2 procedures. Odds ratios (OR) and standard mean difference were calculated for categorical and continuous variables respectively. These were analyzed using random effects model of meta-analysis.

RESULTS:

Nine studies with 483 patients were included in the final analysis. There was no difference in technical success between 2 procedures (OR, 1.78; 95% CI, 0.69 - 4.59), (I2=22%) but EUS-BD was associated with better clinical success (OR, 0.45; 95% CI, 0.23 - 0.89), (I2=0%), fewer postprocedure adverse events (OR, 0.23; 95% CI, 0.12 - 0.47), (I2=57%) and lower rate of re-intervention (OR, 0.13; 95% CI, 0.07 - 0.24), (I2=0%). There was no difference in length of stay in hospital after the procedures, pooled standard mean difference was -0.48 (95% CI, -1.13 - 0.16), but EUS-BD was more cost effective, pooled standard mean difference was -0.63 (95% CI, -1.06 to -0.20). However, the latter 2 analyses were limited by considerable heterogeneity.

CONCLUSIONS:

When ERCP fails to achieve biliary drainage, EUS-guided interventions may be preferred over PTBD if adequate advanced endoscopy expertise and logistics are available. EUS-BD is associated with significantly better clinical success, lower rate of postprocedure adverse events, and fewer re-interventions.