Thématique :
- Endoscopie/Imagerie
Originalité :
Solidité :
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Docteur Florian ROSTAIN
Coup de coeur :
Gastrointestinal Endoscopy
  2017 Jan . pii: S0016-5107(16)30900-2.  
  doi: 10.1016/j.gie.2016.12.023.  
  Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis.  
  Sharaiha RZ, Khan MA, Kamal F, Tyberg A, Tombazzi CR, Ali B, Tombazzi C, Kahaleh M  



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.


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.


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.


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.

Question posée
En cas d’échec de drainage biliaire par CPRE, un drainage sous écho-endoscopie est-il plus efficace et plus sûr qu’un drainage trans-hépatique ?
Question posée
Méta-analyse de 9 études sur 483 patients. Il n’y avait pas de différence entre les 2 techniques en termes de succès technique. Le drainage sous écho-endoscopie était associé à un meilleur taux de succès clinique (OR, 0.45; 95% IC, 0.23 - 0.89), (I2=0%)), un moindre taux d’effets secondaires (OR, 0.23; 95% IC, 0.12 - 0.47), (I2=57%) et un taux plus bas de ré-interventions (OR, 0.13; 95% IC, 0.07 - 0.24), (I2=0%). Il n’y avait pas de différence en termes de durée d’hospitalisation après la procédure.

En cas d’échec de drainage biliaire par CPRE, le drainage sous écho-endoscopie est aussi efficace que le drainage trans-hépatique avec moins d’effets secondaires.
Plusieurs possibilités sont envisageables : des techniques de rendez-vous aux cholédocoduodénostomies, et hépaticogastrostomies.