Efficacy and safety of EUS-guided gallbladder drainage for rescue treatment of malignant biliary obstruction: A systematic review and meta-analysis

• Published in: Endoscopic Ultrasound Vol. 12; no. 1; pp. 8 - 15
• Main Authors: Kamal, Faisal, Khan, Muhammad, Lee-Smith, Wade, Sharma, Sachit, Acharya, Ashu, Farooq, Umer, Aziz, Muhammad, Kouanda, Abdul, Dai, Sun-Chuan, Munroe, Craig, Arain, Mustafa, Adler, Douglas
• Format: Journal Article
• Language: English
• Published: China Wolters Kluwer India Pvt. Ltd 01.01.2023; Medknow Publications and Media Pvt. Ltd; Wolters Kluwer - Medknow
• Subjects: Review; EUS; metaanalysis; gall bladder; malignant biliary obstruction; biliary obstruction
• ISSN: 2303-9027; 2226-7190; 2226-7190
• DOI: 10.4103/EUS-D-21-00206

ERCP is the first line of treatment for malignant biliary obstruction and EUS-guided biliary drainage (EUS-BD) is usually used for patients who have failed ERCP. EUS-guided gallbladder drainage (EUS-GBD) has been suggested as a rescue treatment for patients who fail EUS-BD and ERCP. In this meta-analysis, we have evaluated the efficacy and safety of EUS-GBD as a rescue treatment of malignant biliary obstruction after failed ERCP and EUS-BD. We reviewed several databases from inception to August 27, 2021, to identify studies that evaluated the efficacy and/or safety of EUS-GBD as a rescue treatment in the management of malignant biliary obstruction after failed ERCP and EUS-BD. Our outcomes of interest were clinical success, adverse events, technical success, stent dysfunction requiring intervention, and difference in mean pre- and postprocedure bilirubin. We calculated pooled rates with 95% confidence intervals (CI) for categorical variables and standardized mean difference (SMD) with 95% CI for continuous variables. We analyzed data using a random-effects model. We included five studies with 104 patients. Pooled rates (95% CI) of clinical success and adverse events were 85% (76%, 91%) and 13% (7%, 21%). Pooled rate (95% CI) for stent dysfunction requiring intervention was 9% (4%, 21%). The postprocedure mean bilirubin was significantly lower compared to preprocedure bilirubin, SMD (95% CI): −1.12 (−1.62-−0.61). EUS-GBD is a safe and effective option to achieve biliary drainage after unsuccessful ERCP and EUS-BD in patients with malignant biliary obstruction.