Efficacy and safety of endoscopic ultrasound-guided choledochoduodenostomy compared with endoscopic ultrasound-guided gallbladder drainage for palliation of malignant distal biliary obstruction: a systematic review and meta-analysis.
Saurabh Chandan, Tareq Alsaleh, Douglas G Adler
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In 30 seconds
This systematic review and meta-analysis compared endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with gallbladder drainage (EUS-GBD) for palliation of malignant distal biliary obstruction when ERCP is not feasible or has failed. Five studies included 352 patients. Technical success was 93.3% with EUS-CDS and 95.9% with EUS-GBD (RR, 1.02; 95% CI, 0.94-1.10; P = .6). The analysis found no significant differences between techniques in clinical success, overall or severe adverse events, or stent dysfunction.
Key findings
- Technical success was 93.3% with EUS-CDS and 95.9% with EUS-GBD (RR, 1.02; 95% CI, 0.94-1.10; P = .6).
- Clinical success was 90.1% versus 86.6%, respectively (RR, 0.97; 95% CI, 0.90-1.05; P = .4).
- Overall adverse events occurred in 19.7% with EUS-CDS and 17.6% with EUS-GBD (RR, 0.93; 95% CI, 0.58-1.48; P = .8).
- Stent dysfunction was 15.0% with EUS-CDS and 14.5% with EUS-GBD (RR, 0.95; 95% CI, 0.35-2.58; P = .9).
Why it matters
For malignant distal biliary obstruction requiring palliation when ERCP cannot be performed or has failed, these pooled findings suggest both EUS-guided approaches can achieve high technical and clinical success. The absence of detected differences across key outcomes helps frame the options, while the evidence does not establish that the procedures are equivalent or that one should routinely be preferred.
What to keep in mind
The meta-analysis included only five studies, and the authors state that further prospective studies are needed to corroborate the findings.