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REVIEW ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 101-109

EUS-guided biliary drainage: A systematic review and meta-analysis


1 Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
2 Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA
3 Banner University Medical Center, University of Arizona, Tucson, AZ, USA
4 Division of Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
5 Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
6 Huntsman Cancer Center, University of Utah School of Medicine, Salt Lake City, Utah, USA

Correspondence Address:
Dr. Douglas G Adler
Huntsman Cancer Center, School of Medicine, University of Utah, 30 N 1900 E, Room 4R118, Salt Lake City, Utah 84132
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/eus.eus_80_19

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ERCP is the current procedure of choice for patients with jaundice caused by biliary obstruction. EUS-guided biliary drainage (EUS-BD) has emerged as an alternative to ERCP in patients requiring biliary drainage. The aim of the study was to conduct a systematic review and meta-analysis to report the overall efficacy and safety of EUS-BD. We conducted a comprehensive search of several databases including PubMed, EMBASE, Web of Science, Google Scholar, and LILACS databases (earliest inception to June 2018) to identify studies that reported EUS-BD in patients. The primary outcome was to look at the technical and clinical success of the procedure. The secondary analysis focused on calculating the pooled rate of re-interventions and all adverse-events, along with the commonly reported adverse-event subtypes. Twenty-three studies reporting on 1437 patients were identified undergoing 1444 procedures. Majority of the patient population were male (53.86%), with an average age of 67.22 years. The pooled technical success rates and clinical success rates were 91.5% (95% confidence interval [CI]: 87.7–94.2, I[2] = 76.5) and 87% (95% CI: 82.3–90.6, I[2] = 72.4), respectively. The total adverse event rates were 17.9% (95% CI: 14.3–22.2, I[2] = 69.1). Subgroup analysis of three major individual adverse events was bile leak: 4.1% (2.7–6.2, I[2] = 46.7), stent migration: 3.9% (2.5–6.2, I[2] = 43.5), and infection: 3.8% (2.8–5.1, I[2] = 0) Substantial heterogeneity was noted in the analysis. EUS-BD has high technical and clinical success rate and hence a very effective procedure. Concerns about publication bias exist. Careful consideration should be given to the adverse events and weighing the risks and benefits of the alternative nonsurgical/surgical approaches.


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