Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: When and how?

Table 1 Meta-analysis comparing endoscopic vs biliary drainage before surgery in patients with hilar cholangiocarcinoma

Ref.	No studies	No. patients	Main findings
Liu et al[68]	6	359-EBD; 286-PTBD	Similar technical success rate, R0 resection, incidence of total complications after resection, post-operative hospitalization time, resection time and recurrence; The incidence of total complications were higher in the EBD group (P < 0.05)
Hameed et al[69]	15	398-EBD; 1036-PTBD	There was a trend towards higher procedure conversion (RR 7.36, P = 0.07) and cholangitis (RR 3.36, P = 0.15) in the EBD group
Al Mahjoub et al[70]	4	275-EBD; 158-PTBD	Overall procedure related mortality was higher in EBD group (P = 0.0009); Similar initial technical failure; Conversion rate was higher in EBD group (P < 0.001); Risk of pancreatitis was higher in EBD group (P < 0.001); Risk of cholangitis was higher in EBD group (P < 0.001); Similar postoperative morbidity and mortality
Tang et al[67]	9	498-EBD; 414-PTBD	PTBD was associated with a lower risk of cholangitis (P < 0.001); PTBD was associated with a lower risk of pancreatitis (P = 0.003); A higher successful rate of palliative relief of cholestasis in PTBD group (P < 0.001); The incidence of hemorrhage was similar (P = 0.59)

EBD: Endoscopic biliary drainage; PTBD: Percutaneous biliary drainage; hCCA: Hilar cholangiocarcinoma; RR: Relative risk.