Evolving role of endoscopic ultrasound in biliary stricture management: A meta-analysis and systematic review.

Background: Endoscopic ultrasound (EUS) has evolved from a diagnostic tool to a management technique for various gastroenterological conditions, including biliary strictures.

Aim: To summarize the current evidence on EUS's role in diagnosing and managing biliary strictures.

Methods: Two independent reviewers searched five electronic databases (PubMed, CENTRAL, Science Direct, Google Scholar, and EMBASE) for articles published up to January 2025. Included articles met specific criteria, and statistical software was used to analyze reported outcomes.

Results: Of 935 articles, 19 met the inclusion criteria. Ten articles focused on diagnostic EUS, while nine focused on EUS-guided therapeutic interventions. EUS fine-needle aspiration demonstrated superior sensitivity [0.43-1.00; 95% confidence interval (CI): 0.24-1.00] compared to conventional techniques (0.36-0.96; 95%CI: 0.19-0.99) for diagnosing malignant biliary strictures. Both EUS-fine-needle aspiration and conventional methods exhibited high specificity, with most achieving 100% specificity. EUS-guided interventions showed significantly higher clinical success rates than control interventions (odds ratio = 2.89; 95%CI: 1.22-6.84; P = 0.02). No significant difference was observed in technical success rates (odds ratio = 0.97; 95%CI: 0.30-3.16; P = 0.96).

Conclusion: EUS is a promising tool for diagnosing and managing biliary strictures. Combining EUS-guided and conventional interventions improves diagnostic performance. Further research is needed to investigate the feasibility and use of EUS-guided interventions in this field.