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首页> 外文期刊>Endoscopy International Open >EUS-guided biliary drainage is equivalent to ERCP for primary treatment of malignant distal biliary obstruction: a systematic review and meta-analysis
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EUS-guided biliary drainage is equivalent to ERCP for primary treatment of malignant distal biliary obstruction: a systematic review and meta-analysis

机译：令人调心的胆道引流相当于ERCP，用于初级治疗恶性远端胆量阻塞：系统审查和荟萃分析

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Background and study aims?Although endoscopic retrograde cholangiopancreatography (ERCP) is standard of care for malignant biliary obstruction, endoscopic ultrasound-guided biliary drainage (EUS-BD) as a primary treatment has become increasingly utilized. The aim of this study was to perform a systematic review and meta-analysis to evaluate the effectiveness and safety of EUS-BD for primary treatment of malignant biliary obstruction and comparison to traditional ERCP. Methods?Individualized search strategies were developed through November 2018 using PRISMA and MOOSE guidelines. A cumulative meta-analysis was performed by calculating pooled proportions. Subgroup analysis was performed for studies comparing EUS-BD versus ERCP. Heterogeneity was assessed with Cochran Q test or I sup2/sup statistics, and publication bias by funnel plot and Egger’s tests. Results?Seven studies (n?=?193 patients; 57.5?% males) evaluating primary EUS-BD for malignant biliary obstruction were included. Mean age was 67.4 years (2.3) followed an average of 5.4 months (1.0). For primary EUS-BD, pooled technical success, clinical success, and adverse event (AE) rates were 95?% (95?% CI 91?–?98), 97?% (95?% CI 93?–?100), and 19?% (95?% CI 11?–?29), respectively. Among EUS-BD and ERCP comparator studies, technical and clinical success, and total AEs were not different with lower rates of post-ERCP pancreatitis and reintervention among the EUS-BD group. Conclusion?Primary EUS-BD is an effective treatment with few AE. Comparing EUS-BD versus ERCP, EUS-BD has comparable efficacy and improved safety as a primary treatment for malignant biliary obstruction. Further randomized trials should be performed to identify patient populations and clinical scenarios in which primary EUS-BD would be most appropriate.
机译：背景和研究旨在？尽管内窥镜逆行胆管胆管术（ERCP）是恶性胆道阻塞的标准，但是内窥镜超声引导胆道引流（EUS-BD）作为主要处理越来越多地利用。本研究的目的是进行系统审查和荟萃分析，以评估EUS-BD对恶性胆道阻塞的主要治疗和与传统ERCP的比较的效果和安全性。方法是通过2018年11月开发了个性化的搜索策略，使用PRISMA和MOOSE指南。通过计算汇集比例进行累积的荟萃分析。对比较EUS-BD与ERCP进行研究进行亚组分析。通过Cochran Q测试或I 2 统计分析异质性，并通过漏斗绘图和egger测试出版物偏差。结果？七项研究（N？= 193名患者; 57.5？％雄性）评估原发性EUS-BD用于恶性胆管阻塞。平均年龄为67.4岁（2.3），平均为5.4个月（1.0）。对于原发性EUS-BD，汇集技术成功，临床成功和不良事件（AE）率为95？％（95？％CI 91？ - α0），97？％（95？％CI 93？ - ？100）和19？％（95？％CI 11？ - ？29）分别。在EUS-BD和ERCP比较器中，技术和临床成功，并且总AES与EUS-BD组中的ERCP后胰腺炎和重新实施的较低率不同。结论？主要EUS-BD是少量AE的有效处理。比较EUS-BD与ERCP，EUS-BD具有相当的疗效和改善的安全性作为恶性胆管阻塞的主要治疗方法。应进行进一步随机试验以识别患者群体和临床情景，其中主要EUS-BD最合适。

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