Endoscopic ultrasound-guided biliary drainage versus endoscopic retrograde cholangiopancreatography biliary drainage in the palliative management of malignant distal biliary obstruction: an updated systematic review and meta-analysis of randomized controlled trials
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: Evidence suggests comparable outcomes between endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography(ERCP) in the biliary drainage of malignant distal biliary obstruction (MDBO). We conducted an updated systematicreview and meta-analysis comparing the EUS with ERCP in the management of MDBO. Methods: We performed a literature search using the Medline, Embase and Cochrane databases, including randomized controlled trialscomparing EUS and ERCP in patients with MDBO. Meta-analysis was performed using the random-effects model using the STATAver. 17.0 software. Results: Both procedures were comparable in technical (risk ratio [RR], 1.01; 95% confidence interval [CI], 0.78–1.30) and clinical (RR,1.10; 95% CI, 0.85–1.41) success. No difference was identified in total adverse events (RR, 0.75; 95% CI, 0.42–1.35), acute cholangitis(RR, 0.84; 95% CI, 0.43–1.62), stent patency (RR, 1.13; 95% CI, 0.87–1.46) and mean stent patency time (mean difference, –0.01; 95%CI: –0.21 to 0.19). ERCP was associated with a higher risk of procedure-related pancreatitis (RR, 0.17; 95% CI, 0.04–0.68) and statisticallynon-significant higher risk for reintervention (RR, 0.61; 95% CI, 0.37–1.01). Conclusions: Although EUS and ERCP were comparable in terms of efficacy and safety, ERCP was associated with a higher risk ofprocedure-related pancreatitis and reintervention, with the latter finding not reaching statistical significance.
Abstract
Background/Aims: Evidence suggests comparable outcomes between endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography(ERCP) in the biliary drainage of malignant distal biliary obstruction (MDBO). We conducted an updated systematicreview and meta-analysis comparing the EUS with ERCP in the management of MDBO. Methods: We performed a literature search using the Medline, Embase and Cochrane databases, including randomized controlled trialscomparing EUS and ERCP in patients with MDBO. Meta-analysis was performed using the random-effects model using the STATAver. 17.0 software. Results: Both procedures were comparable in technical (risk ratio [RR], 1.01; 95% confidence interval [CI], 0.78–1.30) and clinical (RR,1.10; 95% CI, 0.85–1.41) success. No difference was identified in total adverse events (RR, 0.75; 95% CI, 0.42–1.35), acute cholangitis(RR, 0.84; 95% CI, 0.43–1.62), stent patency (RR, 1.13; 95% CI, 0.87–1.46) and mean stent patency time (mean difference, –0.01; 95%CI: –0.21 to 0.19). ERCP was associated with a higher risk of procedure-related pancreatitis (RR, 0.17; 95% CI, 0.04–0.68) and statisticallynon-significant higher risk for reintervention (RR, 0.61; 95% CI, 0.37–1.01). Conclusions: Although EUS and ERCP were comparable in terms of efficacy and safety, ERCP was associated with a higher risk ofprocedure-related pancreatitis and reintervention, with the latter finding not reaching statistical significance.