Aaron Pinnola, DO, Yuan Du, Paula Veldhuis, Sebastian De La Fuente. Institute for Surgical Advancement, Florida Hospital Orlando
Introduction: The effectiveness of transpapillary endoscopic retrograde cholangiopancreatography (ERCP) with stenting for palliative relief of biliary obstruction is well established. Recently, technical advances have led to the development of transduodenal endoscopic ultrasound guided biliary drainage (EUS-BD) for use in cases where the native papilla cannot be accessed. Traditionally, this technique has been mainly restricted to settings of a previously failed ERCP, but primary EUS-BD has now garnered interest to avoid ERCP procedure-related complications. In this study, we performed a meta-analysis comparing efficacy and complications of both approaches.
Methods: Articles written in English were searched in Pubmed. Studies with less than 10 patients, studies with no complications reported, when no comparison between techniques was done or studies with pediatric patients were excluded. Primary outcomes were defined as technical success and procedural complications. Secondary outcomes were clinical success and subsequent stent malfunction. Patient demographics and etiology of obstruction were collected. The pooled proportions were computed using either fixed-effects or random-effects models depending on homogeneity or heterogeneity. The Cochran Q test and I2 were used to evaluate for heterogeneity. The 95% CIs were calculated for all points estimates. P-value <0.05 was considered as statistically significant. Statistical analysis was performed using the R software. For binary outcome data, the relative risks (RR) were estimated.
Results: Initial database search yielded 245 studies from which 50 were selected for review, and 7 were chosen based on inclusion criteria for final analysis. There was no statistically different technical success rate found when comparing primary EUS-BD to ERCP RR: 1.04 (95% CI (0.96-1.13)), p=0.33. Likewise, primary EUS-BD compared to ERCP had no statistically different procedural complication rate 1.39 (95% CI (0.47-4.06)), p=0.55. Based on the Egger regression test and symmetric distribution, there was no obvious publication bias detected.
Conclusions: Primary EUS-BD for biliary obstruction was not associated with either an increased risk of procedural complications or technical success. This technique, however should be limited to palliative procedures to avoid biliary leakage and dissemination of malignant cells in patients with resectable disease. Further studies will be needed to assess the procedure’s effect on long term patient outcomes and strict indications for use over primary ERCP.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93465
Program Number: P261
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster