Endoscopic palliation of malignant biliary obstruction

Table 1 Covered versus uncovered self-expandable metal stents in malignant distal biliary obstruction

Ref.	Study design; country	Total number subjects	Number of SEMS Placed, CSEMS vsUSEMS	Recurrent biliary obstruction; CSEMS vsUSEMS, n (%)	Stent patency CSEMS vsUSEMS, d	Procedure related adverse events, CSEMS vsUSEMS, % (n = #)
Sakai et al[13], 2021	Multicenter randomized control trial; Japan	92	44 vs 48	10 (22.7%) vs 21 (43.8%), P = 0.0467	455 vs 301, P = 0.0112	6.8% (2 cholangitis, 1 cholecystitis) vs 8.3% (2 pancreatitis, 2 cholangitis), P = 0.549
Conio et al[14], 2018	Multicenter randomized control trial; Italy	158	78 vs 80	12 (16.7%) vs 10 (13.2%), P = 0.65	240 vs 541, P = 0.031	18% (6 cholangitis, 2 cholecystitis, 5 migrations) vs 7.9% (6 cholangitis), P = 0.061
Yang et al[15], 2015	Single center randomized control trial; South Korea	103	51 vs 52	17 (33.3%) vs 15 (28.8%), P = 0.623	395 vs 365, P = 0.467	17.6% (5 cholecystitis, 3 pancreatitis, 1 cholangitis) vs 9.6% (3 cholecystitis, 2 cholangitis), P = 0.378
Lee et al[16], 2013	Single center randomized control trial; South Korea	40	20 vs 20	10 (50%) vs 4 (20%), P = 0.047	207 vs 413, P = 0.041	5% (1 cholecystitis) vs 0%, NS
Lee et al[17], 2014	Retrospective, single center; USA	749	171 vs 578	33 (19%) vs 123 (21%), P < 0.001	468 vs 799, P = 0.61	8.2% (10 pancreatitis, 4 cholangitis) vs 6.4% (6 pancreatitis, 3 cholecystitis, 28 cholangitis), P = 0.20
Kitano et al[18], 2013	Multicenter randomized control trial; Japan	120	60 vs 60	14 (23%) vs 22 (36%), P = 0.08	583 vs 314, P = 0.019	3.3% (1 pancreatitis, 1 cholecystitis) vs 3.3% (2 cholecystitis), NS
Telford et al[19], 2010	Multicenter randomized control trial; Canada	129	68 vs 61	20 (29%) vs 11 (18%), NS	357 vs 711, P = 0.530	4.4% (3 cholecystitis) vs 6.6% (3 cholecystitis, 1 pancreatitis), P = 0.046
Kullman et al[20], 2010	Multicenter randomized control trial; Sweden	379	188 vs 191	47 (25%) vs 45 (24%), P > 0.50	154 vs 199, P = 0.326	7.5% (2 cholecystitis,3 pancreatitis, 8 cholangitis, 1 perforation) vs 10.5% (2 cholecystitis,4 pancreatitis, 12 cholangitis, 1 perforation, 1 hemorrhage), P = 0.370
Isayama et al[21], 2004	Single center randomized control trial; Japan	112	57 vs 55	8 (14%) vs 21 (38.2%), P < 0.001	304 vs 161, P < 0.05	12.3% (5 pancreatitis, 2 cholecystitis) vs 5.5% (1 pancreatitis, 2 hemorrhage), NS

NS: Not significant; USA: United States.

Table 2 Comparative studies of endoscopic ultrasound guided hepaticogastrostomy and choledochoduodenostomy

Ref.	Study design, Country	Number of HGS vs CDS	Technical success CDS vs HGS, %	Clinical success HGS vs CDS, %	Adverse events, HGS vs CDS, %
Tyberg et al[86], 2022	Multicenter,International	95 vs 87	92% vs 92%, NS	86% vs 100%, NS	21% vs 26%, P = 0.17
Minaga et al[85], 2019	Multicenter, Japan	24 vs 23	87.5% vs 82.6%, P = 0.028	100% vs 94.7%, P = 0.0475	28.6% vs 21%, P = 0.583
Cho et al[94], 2017	Single Center, Korea	21 vs 33	100% vs 100%, NS	86% vs 100%, P = 0.054	19% vs 15%, NS
Amano et al[93], 2017	Single Center, Japan	9 vs 11	100% vs 100%, NS	100% vs 100%, NS	11% vs 18%, NS
Ogura et al[92], 2016	Single Center, Japan	26 vs 13	100% vs 100%	92% vs 100%, P = 0.0497	8% vs 46%, P = 0.005
Guo et al[91], 2016	Single Center, China	7 vs 14	100% vs 100%, NS	100% vs 100%, NS	14% vs 14%, NS
Khashab et al[90], 2016	Multicenter,International	61 vs 60	92% vs 93%, P = 0.75	82% vs 85%, P = 0.64	20% vs 13%, P = 0.37
Artifon et al[84], 2015	Single Center, Brazil	24 vs 25	96% vs 91%	88% vs 70%	20% vs 13%
Poincloux et al[64], 2015	Single Center, France	66 vs 26	94% vs 96.7%, NS	93.8% vs 93.1%, NS	15% vs 7.6%, NS
Kawakubo et al[88], 2014	Multicenter, Japan	20 vs 44	95% vs 95%, NS	95% vs 93%, NS	4% vs 15%, NS
Park et al[89], 2015	Multicenter, Korea	20 vs 12	100% vs 92%, P > 0.99	90% vs 92%, P > 0.99	25% vs 33%, P = 0.044
Prachayakul and Aswakul[87], 2013	Single Center, Thailand	15 vs 6	93% vs 100%, NS	93% vs 100%, NS	0% vs 33%, NS
Kim et al[95], 2012	Single Center, Retrospective	13 (9 CDS; 4 HGS)	100% vs 75%, NS	100% vs 50%, NS	22% vs 50%, NS

NS: Not significant; HGS: Hepaticogastrostomy; CDS: Choledochoduodenostomy.

Table 3 Comparing Photodynamic therapy to endobiliary radiofrequency ablation

Treatment type	Mechanism	Adverse events	Pros	Cons
Photodynamic therapy	Photosensitizing agent is given intravenously 3-4 d prior to accumulate in tissue; then, a fiberoptic probe is introduced to transmit laser light (approximately 630 nm)-apoptosis, necrosis, and immunomodulatory effect	Phototoxicity, erythema, pruritus, blistering, and diffuse pain	Light waves can refract to the proximal biliary tree, beyond the reach of the guidewire	Expensive; highly specialized equipment needed; decreased quality of life (avoid direct sunlight 4-6 wk after treatment); limited to high specialized centers; lack of FDA approval
Endobiliary radiofrequency ablation	High frequency electromagnetic energy-cell death via thermal energy, coagulative necrosis, and indirect anti-tumor lymphocyte activation	Pancreatitis, cholecystitis, cholangitis hemobilia, abdominal pain	Widely available	Lack of standardization; potentially need > 1 session; can only be performed under fluoroscopy