Published online Jul 21, 2022. doi: 10.3748/wjg.v28.i27.3514
Peer-review started: November 23, 2021
First decision: January 9, 2022
Revised: January 21, 2022
Accepted: June 23, 2022
Article in press: June 23, 2022
Published online: July 21, 2022
Processing time: 237 Days and 23.9 Hours
Percutaneous transhepatic cholangiography is a diagnostic and therapeutic procedure. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a novel technique that allows BD whose technicality, success rate, and outcomes are not negligible.
We aimed to compare the technical details and outcomes of 132 studies concerning interventional BD procedures in patients with obstructive cholangiopathy. We conducted a systematic review of six studies that met the inclusion criteria.
To assess the suitability and appropriability of different clinical biliary interventions in achieving optimal BD for obstructive cholangiopathy.
An extensive systematic review was independently conducted by two investigators using an electronic search of different databases, including PubMed, Embase, clinicaltrials.gov, the Cochrane library, Scopus, and Google Scholar, using the guidelines for Preferred Reporting Items for Systematic reviews and Meta-Analyses to identify studies comparing percutaneous transhepatic BD (PTBD) and EUS-BD.
PTBD patients underwent significantly more reinterventions (4.9 vs 1.3), experienced more postprocedural pain (4.1 vs 1.9), and experienced more late adverse events (53.8% vs 6.6%) than EUS-BD patients. There was a significant reduction in the total bilirubin levels in both the groups (16.4-3.3 μmol/L and 17.2-3.8 μmol/L in the EUS-BD and PTBD groups, respectively; P = 0.002) at the postprocedural 7-d follow-up. There were no significant differences in the complication rates between the PTBD and EUS-BD groups (3.3 vs 3.8). PTBD was associated with a higher adverse event rate than EUS-BD in all the procedures, including reinterventions (80.4% vs 15.7%, respectively) and a higher rate of index procedure (39.2% vs 18.2%, respectively).
EUS-BD might be considered as a first-line BD treatment instead of PTBD if the outcomes of clinical studies are favorable and the technical approach is simplified.
EUS-BD following failed ERCP was superior to PTBD in patients with obstructive cholangiopathy.