P3716 - EUS-Guided Biliary Drainage vs ERCP Drainage for Unresectable Malignant Biliary Obstruction: A Systematic Review and Meta-Analysis

Spyros Peppas, MD¹, Akram Ahmad, MBBS², Nadera Altork, MD¹, Sayel H. Alzraikat, MD¹, Amer Arman, MD¹, Won Kyoo Cho, MD^3
1MedStar Health/Georgetown-Washington Hospital Center, Washington, DC; ²MedStar Georgetown Washington Hospital Center, Washington, DC; ³Inova Medical Group, Leesburg, VA

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) with the insertion of self-expandable metal stents (SEMS) has been the preferred treatment modality for the palliation of malignant distal biliary obstruction (MDBO). Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative primary option for relieving MDBO. Potential advantages include lower procedure-related pancreatitis, shorter procedure time and avoidance of placing the stent through the biliary stricture. This systematic review and meta-analysis aimed to compare the outcomes of EUS-BD versus ERCP on relieving MDBO.

Methods: We performed a literature search using the MEDLINE, Embase and Cochrane databases from inception until May 2023 to identify randomized controlled trials (RCTs) comparing the outcomes of EUS-BD and ERCP in patients with MDBO. The outcomes of interest included technical and clinical success, overall adverse events, procedure-related pancreatitis and post-procedural re-intervention. The quality of the studies was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2). Risk ratios (RRs) were calculated and pooled for each outcome. Meta-analysis was performed using the random effects model in STATA 17.0 software.

Results: Four RCTs with 375 patients (EUS-BD: 190 versus ERCP: 185) were included in the meta-analysis with a median follow-up period of 161 days. Both procedures were comparable in technical (RR: 1.10; 95% confidence interval [CI]: 0.82-1.48, Figure 1) and clinical (RR: 1.05; 95% CI: 0.75-1.36, Figure 2) success. No difference was identified on total adverse events between the two groups (EUS-BD: 27/190 versus ERCP: 42/185, RR: 0.79; 95% CI: 0.30-1.64, Figure 3); however, ERCP was associated with significantly more procedure-related pancreatitis events (EUS-BD: 0/190 versus ERCP: 12/185, RR: 0.19; 95% CI: 0.04-0.95, Figure 4). Additionally, the EUS-BD group had a significantly lower risk of requiring re-intervention in the post-procedural period (EUS-BD: 22/190 versus ERCP: 41/185, RR: 0.54; 95% CI: 0.30-0.95, Figure 5).

Discussion: Although, EUS-BD and ERCP techniques had comparable technical and clinical success, and adverse events profile, ERCP was associated with a higher risk of procedural-related pancreatitis and re-intervention. Given the high morbidity associated with pancreatitis and re-intervention after ERCP, EUS could be considered as a first-line treatment option in high-volume expertise institutions.



Disclosures:


Spyros Peppas, MD¹, Akram Ahmad, MBBS², Nadera Altork, MD¹, Sayel H. Alzraikat, MD¹, Amer Arman, MD¹, Won Kyoo Cho, MD³. P3716 - EUS-Guided Biliary Drainage vs ERCP Drainage for Unresectable Malignant Biliary Obstruction: A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.