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Volume 7, Issue 4(Suppl) J Gastrointest Dig Syst, an open access journal
ISSN: 2161-069X Gastro Congress 2017
September 11-12, 2017
September 11-12, 2017 | Paris, France
12th Euro-Global Gastroenterology Conference
Outcomes of endoscopic ultrasound-guided biliary drainage: an updated meta-analysis
Abdellah Hedjoudje
University hospital of Besancon, France
Introduction: Success and event rates of EUS-guided biliary drainage (EUBD) vary with techniques and results from different studies
remain inconsistent. We conducted a proportion meta-analysis to evaluate efficacy and safety of EUBD and compare outcomes of
current procedures and biliary access routes.
Methods: We searched MEDLINE, EMBASE, COCHRANE and SCOPUS to identify studies reporting technical success, clinical
success and complication rate of EUBD techniques with a sample size greater than 10 patients. Weighted pooled rate and 95 %
confident interval were calculated to estimate clinical effectiveness and safety of EUBD procedures.
Results: We identified 39 studies including a total of 1640 patients. The overall technical success, per-protocol clinical success and
complications rates with 95 % confidence interval were 89% [86 %-92 %], 92% [90 %-94 %] and 20 % (16-24%), respectively. When
comparing choledochoduodenostomy with hepaticogastrostomy the pooled 95% CI OR for was 0.78 [0.41; 1.50] (p = 0.462) for
technical success and 0.85 [0.51-1.42] (p-val = 0.536) for clinical success. However, pooled OR was 0.65 IC 95% [0.42-0.99] (p-val
= 0.047) for complication rate suggesting that EUS-guided choledochoduodenostomy is safer than hepaticogastrostomy. The pooled
OR when using the extra-hepatic approach was 1.03 [0.65-1.61] and 0.94 [0.56-1.57] (p-val = 0.804) for technical and clinical success
rate respectively. Pooled odds-ratio for adverse events was 0.81 [0.58-1.14] (p-val = 0.221) when using the extra-hepatic approach.
Regarding transpapillary technique including Rendezvous and anterograde stenting, technical success, clinical success and adverse
event rate were 77% IC 95[71-82], 92% IC95% [83-96%] and 19% IC95%[15%-25%] respectively.
Conclusion: EUS-guided biliary drainage appears to be an effective treatment when ERCP fails with a high success rate and an
acceptable adverse event rate. The available literature suggests choledochoduodenosomy to be a safer approach compared to
hepaticogastrostomy. Transluminal approaches demonstrate a higher efficacy than transpapillary technique with a similar safety.
Randomized controlled trials with sufficiently large cohorts are needed to compare techniques and confirm these findings.
Biography
Abdellah Hedjoudje is a French Resident in Gastroenterology at the University Hospital of Besancon. He holds degrees in Bioinformatics, Data Science and
Statistics, his research focuses on methodological evaluation, critical appraisal, and qualitative and quantitative synthesis of medical literature using cutting edges
big data and meta-analysis techniques.
Abdellah Hedjoudje, J Gastrointest Dig Syst 2017, 7:4(Suppl)
DOI: 10.4172/2161-069X-C1-052