Abstract：
BACKGROUND: Endoscopic ultrasound-guided biliary drainage (EUS-BD) is an alternative to endoscopic retrograde cholangiopancreatography (ERCP)-guided transpapillary drainage in malignant distal biliary obstruction (MDBO). This meta-analysis of randomized controlled trials (RCTs) aims to compare the outcomes of these 2 approaches.
METHODS: Electronic databases from January 2005 through December 2023 were searched for RCTs comparing outcomes of EUS-BD and ERCP for treating MDBO. Pooled proportions, risk ratio (RR), and odds ratio were calculated using random-effects models.
RESULTS: Five RCTs comprising 519 patients were included in the final analysis. The pooled RR for overall technical success with EUS-BD compared with ERCP was 1.05 (95% confidence interval [CI] = 0.96-1.16, P = 0.246, I2 = 61%) and for clinical success was 0.99 (95% CI = 0.95-1.04, P = 0.850, I2 = 0%). The pooled rate of procedure-related pancreatitis was 7.20% (95% CI = 3.60-13.80, I2 = 34%) in the ERCP group compared with zero in the EUS-BD group. The pooled RR for stent dysfunction with EUS-BD compared with ERCP was 0.48 (95% CI = 0.28-0.83, P = 0.008, I2 = 7%). The weighted mean procedure time was 13.43 (SD = 10.12) minutes for EUS-BD compared with 21.06 (SD = 6.64) minutes for ERCP. The mean stent patency was 194.11 (SD = 52.12) days in the EUS-BD group and 187 (SD = 60.70) days in the ERCP group.
CONCLUSIONS: EUS-BD is an efficient and safe alternative to ERCP in MDBO. An almost nonexistent risk of procedure-related pancreatitis, lower procedure time, and ease of use make this an attractive primary approach to biliary decompression in centers with expertise.
METHODS: Electronic databases from January 2005 through December 2023 were searched for RCTs comparing outcomes of EUS-BD and ERCP for treating MDBO. Pooled proportions, risk ratio (RR), and odds ratio were calculated using random-effects models.
RESULTS: Five RCTs comprising 519 patients were included in the final analysis. The pooled RR for overall technical success with EUS-BD compared with ERCP was 1.05 (95% confidence interval [CI] = 0.96-1.16, P = 0.246, I2 = 61%) and for clinical success was 0.99 (95% CI = 0.95-1.04, P = 0.850, I2 = 0%). The pooled rate of procedure-related pancreatitis was 7.20% (95% CI = 3.60-13.80, I2 = 34%) in the ERCP group compared with zero in the EUS-BD group. The pooled RR for stent dysfunction with EUS-BD compared with ERCP was 0.48 (95% CI = 0.28-0.83, P = 0.008, I2 = 7%). The weighted mean procedure time was 13.43 (SD = 10.12) minutes for EUS-BD compared with 21.06 (SD = 6.64) minutes for ERCP. The mean stent patency was 194.11 (SD = 52.12) days in the EUS-BD group and 187 (SD = 60.70) days in the ERCP group.
CONCLUSIONS: EUS-BD is an efficient and safe alternative to ERCP in MDBO. An almost nonexistent risk of procedure-related pancreatitis, lower procedure time, and ease of use make this an attractive primary approach to biliary decompression in centers with expertise.
摘要：
目的：内镜超声引导下胆道引流（EUS-BD）是经内镜逆行胰胆管造影术（ERCP）引导下的经乳头引流治疗恶性远端胆道梗阻（MDBO）的替代方法。这项随机对照试验（RCT）的荟萃分析旨在比较这两种方法的结果。
方法：检索了2005年1月至2023年12月的电子数据库，以比较EUS-BD和ERCP治疗MDBO的结果。汇集比例，风险比率，和比值比使用随机效应模型计算。
结果：最终分析包括519例患者的5个随机对照试验。与ERCP相比，EUS-BD的总体技术成功的合并风险比（RR）为1.05（95％CI=0.96-1.16，p=0.246，I2=61％），临床成功率为0.99（95％CI=0.95-1.04，p=0.850，I2=0％）。ERCP组手术相关胰腺炎的合并率为7.20%（95%CI=3.60-13.80，I2=34%），而EUS-BD组为零。与ERCP相比，EUS-BD支架功能障碍的合并RR为0.48（95％CI=0.28-0.83，p=0.008，I2=7％）。EUS-BD的加权平均手术时间为13.43（SD=10.12）分钟，而ERCP为21.06（SD=6.64）分钟。EUS-BD组的平均支架通畅率为194.11(SD=52.12)天，ERCP组为187(SD=60.70)天。
结论：EUS-BD是MDBO中ERCP的一种有效且安全的替代品。手术相关性胰腺炎的风险几乎不存在，较低的手术时间，和易用性使其成为在具有专业知识的中心进行胆道减压的有吸引力的主要方法。
方法：检索了2005年1月至2023年12月的电子数据库，以比较EUS-BD和ERCP治疗MDBO的结果。汇集比例，风险比率，和比值比使用随机效应模型计算。
结果：最终分析包括519例患者的5个随机对照试验。与ERCP相比，EUS-BD的总体技术成功的合并风险比（RR）为1.05（95％CI=0.96-1.16，p=0.246，I2=61％），临床成功率为0.99（95％CI=0.95-1.04，p=0.850，I2=0％）。ERCP组手术相关胰腺炎的合并率为7.20%（95%CI=3.60-13.80，I2=34%），而EUS-BD组为零。与ERCP相比，EUS-BD支架功能障碍的合并RR为0.48（95％CI=0.28-0.83，p=0.008，I2=7％）。EUS-BD的加权平均手术时间为13.43（SD=10.12）分钟，而ERCP为21.06（SD=6.64）分钟。EUS-BD组的平均支架通畅率为194.11(SD=52.12)天，ERCP组为187(SD=60.70)天。
结论：EUS-BD是MDBO中ERCP的一种有效且安全的替代品。手术相关性胰腺炎的风险几乎不存在，较低的手术时间，和易用性使其成为在具有专业知识的中心进行胆道减压的有吸引力的主要方法。
