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      Efficacy and safety of EUS-guided gallbladder drainage for rescue treatment of malignant biliary obstruction: A systematic review and meta-analysis

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          ABSTRACT

          ERCP is the first line of treatment for malignant biliary obstruction and EUS-guided biliary drainage (EUS-BD) is usually used for patients who have failed ERCP. EUS-guided gallbladder drainage (EUS-GBD) has been suggested as a rescue treatment for patients who fail EUS-BD and ERCP. In this meta-analysis, we have evaluated the efficacy and safety of EUS-GBD as a rescue treatment of malignant biliary obstruction after failed ERCP and EUS-BD. We reviewed several databases from inception to August 27, 2021, to identify studies that evaluated the efficacy and/or safety of EUS-GBD as a rescue treatment in the management of malignant biliary obstruction after failed ERCP and EUS-BD. Our outcomes of interest were clinical success, adverse events, technical success, stent dysfunction requiring intervention, and difference in mean pre- and postprocedure bilirubin. We calculated pooled rates with 95% confidence intervals (CI) for categorical variables and standardized mean difference (SMD) with 95% CI for continuous variables. We analyzed data using a random-effects model. We included five studies with 104 patients. Pooled rates (95% CI) of clinical success and adverse events were 85% (76%, 91%) and 13% (7%, 21%). Pooled rate (95% CI) for stent dysfunction requiring intervention was 9% (4%, 21%). The postprocedure mean bilirubin was significantly lower compared to preprocedure bilirubin, SMD (95% CI): −1.12 (−1.62–−0.61). EUS-GBD is a safe and effective option to achieve biliary drainage after unsuccessful ERCP and EUS-BD in patients with malignant biliary obstruction.

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          Most cited references23

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          Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.

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            Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis.

            EUS-guided biliary drainage (EUS-BD) is increasingly used as an alternate therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for biliary obstruction in patients who fail ERCP. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures.
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              Endoscopic ultrasound-guided biliary drainage after failed ERCP: cumulative experience of 101 procedures at a single center.

              Endoscopic ultrasound (EUS)-guided biliary access is an alternative to percutaneous access after failed endoscopic retrograde cholangiopancreatography (ERCP). This report presents 7 years' cumulative experience of EUS-guided biliary drainage for obstructive jaundice in patients with failed ERCP.
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                Author and article information

                Journal
                Endosc Ultrasound
                Endosc Ultrasound
                EUS
                Endosc Ultrasound
                Endoscopic Ultrasound
                Wolters Kluwer - Medknow (India )
                2303-9027
                2226-7190
                Jan-Feb 2023
                23 October 2022
                : 12
                : 1
                : 8-15
                Affiliations
                [1 ]Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
                [2 ]Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, USA
                [3 ]Mulford Health Science Library, University of Toledo, Toledo, OH, USA
                [4 ]Department of Medicine, University of Toledo, Toledo, OH, USA
                [5 ]Department of Medicine, Loyola Medicine MacNeal Hospital, Berwyn, IL, USA
                [6 ]Division of Gastroenterology, University of Toledo, Toledo, OH, USA
                [7 ]Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, FL, USA
                [8 ]Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, CO, USA
                Author notes
                Address for correspondence Dr. Douglas G. Adler, Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, 2525 S Downing St, Denver, CO 80210, USA. E-mail: Douglasadler@ 123456centura.org
                Article
                EUS-12-8
                10.4103/EUS-D-21-00206
                10134926
                36861505
                64762e7b-fc38-4226-9b39-c873103aefc9
                Copyright: © 2022 SCHOLAR MEDIA PUBLISHING

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 26 September 2021
                : 24 April 2022
                Categories
                Review Article

                biliary obstruction,eus,gall bladder,malignant biliary obstruction,metaanalysis

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