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REVIEW ARTICLE
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Efficacy and safety of EUS-guided gallbladder drainage for rescue treatment of malignant biliary obstruction: A systematic review and meta-analysis


1 Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
2 Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, USA
3 Mulford Health Science Library, University of Toledo, Toledo, OH, USA
4 Department of Medicine, University of Toledo, Toledo, OH, USA
5 Department of Medicine, Loyola Medicine MacNeal Hospital, Berwyn, IL, USA
6 Division of Gastroenterology, University of Toledo, Toledo, OH, USA
7 Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, FL, USA
8 Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, CO, USA

Correspondence Address:
Douglas G Adler,
Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, 2525 S Downing St, Denver, CO 80210
USA
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-21-00206

ERCP is the first line of treatment for malignant biliary obstruction and EUS-guided biliary drainage (EUS-BD) is usually used for patients who have failed ERCP. EUS-guided gallbladder drainage (EUS-GBD) has been suggested as a rescue treatment for patients who fail EUS-BD and ERCP. In this meta-analysis, we have evaluated the efficacy and safety of EUS-GBD as a rescue treatment of malignant biliary obstruction after failed ERCP and EUS-BD. We reviewed several databases from inception to August 27, 2021, to identify studies that evaluated the efficacy and/or safety of EUS-GBD as a rescue treatment in the management of malignant biliary obstruction after failed ERCP and EUS-BD. Our outcomes of interest were clinical success, adverse events, technical success, stent dysfunction requiring intervention, and difference in mean pre- and postprocedure bilirubin. We calculated pooled rates with 95% confidence intervals (CI) for categorical variables and standardized mean difference (SMD) with 95% CI for continuous variables. We analyzed data using a random-effects model. We included five studies with 104 patients. Pooled rates (95% CI) of clinical success and adverse events were 85% (76%, 91%) and 13% (7%, 21%). Pooled rate (95% CI) for stent dysfunction requiring intervention was 9% (4%, 21%). The postprocedure mean bilirubin was significantly lower compared to preprocedure bilirubin, SMD (95% CI): −1.12 (−1.62–−0.61). EUS-GBD is a safe and effective option to achieve biliary drainage after unsuccessful ERCP and EUS-BD in patients with malignant biliary obstruction.


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