Endoscopic ultrasound‐guided versus endoscopic retrograde cholangiopancreatography‐guided biliary drainage for primary treatment of distal malignant biliary obstruction: A systematic review and meta‐analysis

Objectives Current evidence supporting the utility of endoscopic ultrasound‐guided biliary drainage ( EUS ‐ BD ) as primary treatment for distal malignant biliary obstruction ( MBO ) is limited. We conducted a meta‐analysis to compare the performance of EUS ‐ BD and endoscopic retrograde cholangiopancreatography‐guided biliary drainage ( ERCP ‐ BD ) as primary palliation of distal MBO . Methods We searched several databases for comparative studies evaluating EUS ‐ BD vs. ERCP ‐ BD in primary drainage of distal MBO up to 28 February 2019. Primary outcomes were technical success and clinical success. Secondary outcomes included adverse events, stent patency, stent dysfunction, tumor in/overgrowth, reinterventions, procedure duration, and overall survival. Results Four studies involving 302 patients were qualified for the final analysis. There was no difference in technical success (risk ratio [ RR ] 1.00; 95% confidence interval [95% CI ] 0.93–1.08), clinical success ( RR 1.00; 95% CI 0.94–1.06) and total adverse events ( RR 0.68; 95% CI : 0.31–1.48) between the two procedures. EUS ‐ BD was associated with lower rates of post‐procedure pancreatitis ( RR 0.12; 95% CI 0.02–0.62), stent dysfunction ( RR 0.54; 95% CI 0.32–0.91), and tumor in/overgrowth ( RR 0.22; 95% CI 0.07–0.76). No differences were noted in reinterventions ( RR 0.59; 95% CI 0.21–1.69), procedure duration (weighted mean difference −2.11; 95% CI −9.51 to 5.29), stent patency (hazard ratio [ HR ] 0.61; 95% CI 0.34–1.11), and overall survival ( HR 1.00; 95% CI 0.66–1.51). Conclusions With adequate endoscopy expertise, EUS ‐ BD could show similar efficacy and safety when compared with ERCP ‐ BD for primary palliation of distal MBO and exhibits several clinical advantages.