Efficacy and safety of endoscopic ultrasonography (EUS) hepaticogastrostomy (HGS) versus choledochoduodenostomy (CDS) in ERCP-failed malignant biliary obstruction: A systematic review and META-analysis

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY
JGH Open Pub Date : 2024-10-22 DOI:10.1002/jgh3.70037
Chrisandi Y Rizqiansyah, Putu I D Awatara, Nasim Amar, Cosmas R A Lesmana, Syifa Mustika
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引用次数: 0

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard in managing malignant biliary obstruction. The success of ERCP has limitations, whereas surgical biliary bypass and percutaneous transhepatic approaches, as alternative modalities, come with significant costs, longer durations, and higher levels of mortality and morbidity. Endoscopic ultrasonography (EUS)-guided biliary drainage with two approaches, hepaticogastrostomy (EUS-HGS) and choledochoduodenostomy (EUS-CDS), is a favored and evolving alternative modality. This study aims to compare the efficacy and safety of EUS-HGS and EUS-CDS. We conducted a systematic review and meta-analysis by searching PubMed, ScienceDirect, Cochrane Library, and Scholar databases up to August 2023, based on the 2020 PRISMA guidelines. We identified randomized and nonrandomized studies comparing the efficacy and safety of EUS-HGS and EUS-CDS. Outcome measures included technical and clinical success, side effects, and mean procedure time. Nine nonrandomized studies and two randomized controlled trials involving 537 patients (225 EUS-HGS, 312 EUS-CDS) were analyzed. No difference was found in technical success (OR, 0.83; 95% CI, 0.41–1.68; I2 = 0%) and clinical success between the two procedures (OR, 0.96; 95% CI, 0.51–1.81; I2 = 9.94%). Side effects were significantly higher in EUS-HGS (OR, 2.01, 95% CI, 1.14–3.59; I2 = 0%). No significant difference in mean procedure time was observed between the two procedures (0.13; 95% CI, −0.15–0.41; I2 = 34.89%). There are differences in efficacy and safety between EUS-HGS and EUS-CDS. EUS-CDS has a faster procedure time, lower risk of side effects, and ease of puncture during the procedure.

Abstract Image

内镜超声造影肝胃造口术(HGS)与胆总管十二指肠造口术(CDS)在ERCP失败的恶性胆道梗阻中的有效性和安全性:系统回顾和 META 分析。
内镜逆行胰胆管造影术(ERCP)是治疗恶性胆道梗阻的金标准。ERCP 的成功有其局限性,而外科胆道分流术和经皮经肝方法作为替代方式,成本高昂,持续时间长,死亡率和发病率较高。内镜超声(EUS)引导下的胆道引流术有两种方法:肝胃造口术(EUS-HGS)和胆总管十二指肠造口术(EUS-CDS),这是一种备受青睐且不断发展的替代方法。本研究旨在比较 EUS-HGS 和 EUS-CDS 的有效性和安全性。我们根据 2020 年 PRISMA 指南,检索了 PubMed、ScienceDirect、Cochrane Library 和 Scholar 数据库(截至 2023 年 8 月),进行了系统综述和荟萃分析。我们确定了比较 EUS-HGS 和 EUS-CDS 疗效和安全性的随机和非随机研究。结果指标包括技术和临床成功率、副作用和平均手术时间。共分析了九项非随机研究和两项随机对照试验,涉及 537 名患者(225 名 EUS-HGS,312 名 EUS-CDS)。两种手术的技术成功率(OR,0.83;95% CI,0.41-1.68;I 2 = 0%)和临床成功率(OR,0.96;95% CI,0.51-1.81;I 2 = 9.94%)没有差异。EUS-HGS 副作用明显更高(OR,2.01;95% CI,1.14-3.59;I 2 = 0%)。两种手术的平均手术时间无明显差异(0.13;95% CI,-0.15-0.41;I 2 = 34.89%)。EUS-HGS 和 EUS-CDS 在疗效和安全性方面存在差异。EUS-CDS 的手术时间更快,副作用风险更低,且在手术过程中易于穿刺。
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来源期刊
JGH Open
JGH Open GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
3.40
自引率
0.00%
发文量
143
审稿时长
7 weeks
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