Introduction
Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a novel technique that allows biliary drainage by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract. Percutaneous transhepatic cholangiography biliary drainage (PTBD) is a diagnostic and therapeutic procedure that involves inserting a needle into the biliary tree, followed by the immediate insertion of a catheter. This study examined the technical aspects and outcomes of these different approaches to biliary drainage.
Materials and methods
We compared the technical aspects and outcomes of two different approaches to biliary drainage: EUS-BD and PTBD. Different databases (including PubMed, Embase, ClinicalTrials.gov, the Cochrane library, Scopus and Google Scholar) were searched according to the PRISMA guidelines to obtain studies comparing PTBD and EUS-BD.
Results
Among the six studies that fulfilled the inclusion criteria, PTBD patients underwent significantly more reinterventions (4.9 vs 1.3), experienced more post-procedure pain (4.1 vs 1.9) and experienced more late adverse events (53.8% vs 6.6%) than EUS-BD patients (Table 1).1–6 The EUS-BD group had a higher success rate of biliary drainage (92% vs 46%; p>0.05) and a lower rate of adverse events (20% vs 46%; p=0.05) than PTBD group. There was a significant reduction in total bilirubin in both groups (from 16.4 μmol/L to 3.3 μmol/L for EUS-BD and 17.2 μmol/L to 3.8 μmol/L for PTBD; p=0.002) at the 7-day follow-up. There were no significant differences observed for complication rates between PTBD and EUS-BD (3.3 vs 3.8, respectively). PTBD was associated with a higher adverse event rate than EUS-BD in all procedures, including reinterventions (80.4% vs 15.7%, respectively) and a higher index procedure (39.2% vs 18.2%, respectively).
Table 1.
Rates of clinical and technical success in the included studies
| Study | Technical success | Clinical success | ||
|---|---|---|---|---|
| EGBD, event/total cases, n | PTBD, event/total cases, n | EGBD, event/total cases, n | PTBD, event/total cases, n | |
| Artifon et al1 | 13/13 | 12/12 | 13/13 | 12/12 |
| Bapaye et al2 | 23/25 | 26/26 | 23/25 | 26/26 |
| Khashab et al3 | 19/22 | 51/51 | 19/19 | 47/51 |
| Giovannini et al4 | 19/20 | 17/17 | 18/19 | 17/17 |
| Jung et al5 | 32/34 | 31/32 | 28/32 | 27/31 |
| Sharaiha et al6 | 43/47 | 12/13 | 27/43 | 3/12 |
EGBD = endoscopic ultrasound-guided choledochoduodenostomy; PTBD = percutaneous transhepatic biliary drainage.
Conclusion
The findings of this systematic review revealed that EUS-BD is linked with a higher rate of effective biliary drainage and a more manageable procedure-related adverse event profile than PTBD. EUS-BD could become a first-line biliary drainage treatment instead of endoscopic retrograde cholangiopancreatography if the outcomes of clinical studies are positive and technologies are simplified. Prospective, randomised controlled studies are required to clarify these issues.
References
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