Therapeutic interventional endoscopic ultrasound in pancreato-biliary disorders: Does it really replace the surgical/percutaneous approach?

Table 1 Summary of comparison studies involving endoscopic ultrasound-guided biliary drainage in patients with biliary obstruction

Ref.	Design	Cases	Number of patients	Success rates	Complication rate
Tyberg et al[15]	Retrospective study	Patients with biliary obstruction who failed conventional ERCP	52	Technical success rate: 96%. Clinical success rate: 77%	Adverse events: 10%
Khashab et al[13]	Retrospective comparative cohort study	Patients who underwent EUS-BD or PTBD with distal malignant biliary obstruction after at least one failed ERCP attempt	73	Technical success rate: EUS-BD vs PTBD: 86.4% vs 100%. Clinical success rate: EUS-BD vs PTBD: 86.4% vs 92.2%	Adverse events: EUS-BD vs PTBD: 18.2% vs 39.2%. Re-intervention: EUS-BD vs PTBD: 15.7% vs 80.4%
Sharaiha et al[10]	Systematic review and meta-analysis	Patients who underwent EUS-BD or PTBD with biliary obstruction and failure of ERCP to obtain drainage	483	Technical success rate: OR 1.78 (P = 0.25). Clinical success rate: OR 0.45 (P = 0.66) in favor of EUS-BD	Adverse events: OR 0.23 (P = 0.02). Re-intervention: OR 0.13 (P = 0.77) in favor of EUS-BD
Téllez-Ávila et al[14]	Retrospective comparative study	Patients who underwent EUS-BD or PTBD with biliary obstruction and had at least one previous failed ERCP attempt or difficulty in accessing the second portion of duodenum	90	Technical success rate: EUS-BD vs PTBD: 90% vs 78% (P = 0.3). Clinical success rate: EUS-BD vs PTBD: 96% vs 63% (P = 0.04)	Complications: EUS-BD vs PTBD: 6.6% vs 28% (P = 0.04). Length of hospital stay: EUS-BD vs PTBD: 6.5 d vs 12.5 d (P = 0.009)
Poincloux et al[16]	Retrospective study	Patients with malignant and benign biliary obstruction with previous failed ERCP attempt who underwent EUS intra- or extra-hepatic approach with transluminal stenting or rendezvous procedure with trans-papillary stent placement	101	Technical success rate: 98%. Clinical success rate: 92.1%	Adverse event rate: 11.9%. Six procedure-related deaths
Lesmana et al[12]	Retrospective study	Patients with advanced malignant biliary obstruction, who underwent EUS-BD after failed ERCP attempt	38	Technical success rate: EUS-BD vs PTBD: 87.5%% vs 86.7% (P = 1.000). Clinical success rate: EUS-BD vs PTBD: 62.5% vs 93.3% (P = 0.5)	Adverse events: EUS-BD vs PTBD: 1 patient vs 0 patient
Han et al[17]	Systematic review and meta-analysis	Patients with malignant distal biliary obstruction who underwent EUS-BD with transmural metal stenting or ERCP for primary palliative treatment	756	Technical success rate: EUS-BD vs ERCP: 94.8% vs 96.5%. Clinical success rate: EUS-BD vs ERCP: 93.8% vs 95.7%	Adverse event rate: EUS-BD vs ERCP: 16.3% vs 18.3%
Moole et al[11]	Systematic review and meta-analysis	Patients with inoperable malignant biliary strictures with a failed ERCP attempt, who underwent EUS-BD or PTBD	528	Success rate: EUS-BD vs PTBD (pooled OR): 3.06	Risk difference for overall procedure-related complications in EUS-BD vs PTBD: -0.21. Relative risk for infectious complications and bile leak: EUS-BD vs PTBD: 0.25 vs 0.33
Artifon et al[18]	Prospective and randomized trial	Patients with unresectable malignant distal biliary obstruction (with history of failed standard ERCP) treated with EUS-guided choledochoduodenostomy (EUS-CDT) or surgical biliary bypass or hepaticojejunostomy (HJT)	32	Technical success rates: EUS-CDT vs HJT: 88% vs 94% (P = 0.598). Clinical success rates: EUS-CDT vs HJT: 71% vs 93% (P = 0.169)	Complication rates: EUS-CDT vs HJT: 21.42% vs 13.33% (P = 0.651). Median survival: EUS-CDT vs HJT: 82.36 d vs 82.27 d. 90-d mortality: EUS-CDT vs HJT: 42.9% vs 60% (P = 0.389)

ERCP: Endoscopic retrograde cholangiopancreatography; EUS-BD: Endoscopic ultrasound-guided biliary drainage; PTBD: Percutaneous transhepatic biliary drainage; OR: Odds ratio.

Table 2 Summary of comparative studies of endoscopic ultrasound-guided management of pancreatic pseudocysts

Ref.	Design	Cases	Number of patients	Technical success rate	Complication rate
Farias et al[30]	Systematic review and meta-analysis	Pancreatic pseudocysts	342	Risk difference: -0.09 (P = 0.07)	Drainage-related adverse events: risk difference: -0.02 (P = 0.48). General adverse events: risk difference: -0.05 (P = 0.13).
Szakó et al[31]	Meta-analysis	Pseudocysts and walled-off necrosis	842-896	OR 0.59 (P = 0.022): lower clinical success of endoscopic approach	Mortality: OR 0.86 (P = 0.870): similar result. Post-operative length of hospital stay: -3.67 (P < 0.001)
Varadarajulu et al[32]	Randomized trial	Pancreatic pseudocysts	40	Risk difference: -5% (P = 0.5)	Risk difference: -10% (P = 0.24). Median of hospital stay: -4 days (P < 0.001): shorter in endoscopic cytogastrostomy

OR: Odds ratio.

Table 3 Summary of studies comparing endoscopic ultrasound-guided gastroenterostomy/endoscopic ultrasound-guided gastro-jejunostomy with surgical procedures in patients with gastric outlet obstruction

Ref.	Design	Cases	Number of patients	Technical success rate	Complication rate
Khashab et al[35]	Retrospective study	Patients with malignant gastric outlet obstruction who underwent EUS-GE or surgical gastrojejunostomy (SGJ)	93	Technical success rate: EUS-GE vs SGJ: 87% vs 100% (P = 0.009). Clinical success rate: EUS-GE vs SGJ: 87% vs 90% (P = 0.8)	Recurrence rate: EUS-GE vs SGJ: 3% vs 14% (P = 0.2). Adverse event rate: EUS-GE vs SGJ: 16% vs 25% (P = 0.3). Length of stay: EUS-GE vs SGJ: 11.6 ± 6.6 d vs 12 ± 8.2 d (P = 0.35)
Perez-Miranda et al[36]	Retrospective study	Patients with gastric outlet obstruction who underwent EUS-guided gastrojejunostomy (EUS-GJ) or laparoscopic gastrojejunostomy (Lap-GJ)	54	Technical success rate: EUS-GJ vs Lap-GJ: 88% vs 100% (P = 0.11). Clinical success rate: EUS-GJ vs Lap-GJ: 84% vs 90% (P = 0.11)	Adverse event rate: EUS-GJ vs Lap-GJ: 12% vs 41% (P = 0.0386)
Jayaraj et al[37]	Systematic review and meta-analysis	Patients with malignant gastric outlet obstruction who underwent EUS-GE and surgical GE	171	Technical success rate: pooled OR: 0.16 (P = 0.033). Clinical success rate: pooled OR: 0.98 (P = 0.984)	Overall adverse event rate: pooled OR: 0.35 (P = 0.014)
Kouanda et al[38]	Retrospective study	Patients with gastric outlet obstruction who underwent EUS-GE or open gastrojejunostomy (OGJ)	66	Technical success rate: EUS-GE vs OGJ: 92.5% vs 100% (P = 0.15)	Recurrence of the symptoms: EUS-GE vs OGJ: 17.5% vs 19.2% (P = 0.34). Re-intervention rate: EUS-GE vs OGJ: 20% vs 11.5% (P = 0.78). Resumption of oral intake: EUS-GE vs OGJ: 1.3 d vs 4.7 d (P < 0.001). Length of hospital stay: EUS-GE vs OGJ: 5 d vs 14.5 d (P < 0.001). 30-d readmission rate: EUS-GE vs OGJ: 17.5% vs 24.1% (P = 0.37)

EUS-GE: Endoscopic ultrasound-guided gastroenterostomy; OR: Odds ratio.