J Gastroenterol Hepatol Endosc | Volume 6, Issue 1 | Research Article | Open Access

Endosonography-Guided Biliary Drainage versus Percutaneous Transhepatic Biliary Drainage in the Falls of Endoscopic Retrograde Cholangiopancreatography: Systematic Review and Meta-Analyses

Juan Pablo Román Serrano1,2*, Samuel Galante Romanini2, Paúl Fernando Guamán Aguilar3, Juliana Silveira Lima de Castro
4, Isabela Trindade Torres2, José Andres Sanchez Pulla5, André Lucchiari Borini2, Juan Eduardo Gonzales2, Jose Jukemura1
and José Celso Ardengh6

1Department of Gastroenterology, University of Sao Paulo, Brazil
2Department of Gastrointestinal Endoscopy, Hospital 9 de Julho, Brazil
3Catholic University of Cuenca, Ecuador
4Department of Gastrointestinal Endoscopy, AC Camargo Center of Cancer, Brazil
5Department of Surgery, Servidor Estadual Hospital, Brazil
6Department of Gastrointestinal Endoscopy, Hospital 9 de Julho, and University of Sao Paulo, Riberao Preto, Brazil

*Correspondance to: Juan Pablo Rom├ín Serrano 

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Background and Aims:The Endoscopic Retrograde Cholangiopancreatography (ERCP) is currently used for therapeutic purposes. In experienced hands the success rate is over 95%. The failure of ERCP to drain the bile duct in patients with biliary obstruction varies between 6% and 7%. In order to remedy failures, alternative techniques have emerged, such as Percutaneous Transhepatic Biliary Drainage (PTBD) and Endosonography-guided Biliary Drainage (EUS-BD). The objective of this systematic review was to assess which of the two techniques would be the best choice after ERCP failure.

Materials  and  Methods: We  searched  the  databases,  such  as  MEDLINE,  Embase  and  Cochrane Central  Library. Literature  articles  comparing  EUS-BD vs.  PTBD  were  included:  randomized, prospective, non-randomized and retrospective trials.

Results:Fourteen articles were selected among them: randomized clinical trials (3), retrospective (10) and non-randomized prospective (1). Overall, we obtained 1,281 patients: 759 allocated to the EUS-BD group (intervention) and 522 to the PTBD group (comparison). Technical and clinical success was not statistically significant. And in relation to the number of adverse events, it had better statistical significance in the cases of RCTs. In technical success the risk difference IC 95%: 0.03 (-0.05, 0.11) with p>0.05 with heterogeneity of 26%, in clinical success the risk difference IC 95%: 0.00 (-0.12, 0.13) with p>0.05 with 0% heterogeneity. And in adverse events the risk difference IC 95%: -0.23 (-0.36, -0.09) with p<0.05 with 0% heterogeneity.

Conclusion:Technical success and clinical success did not have statistical significance, but with adverse events, the technique through endosonography had a decrease with adverse events.


Endoscopic retrograde cholangiopancreatography; Drainage; Percutaneous; Failed and endoscopic ultrasonography


Román Serrano JP, Romanini SG, Guamán Aguilar PF, Lima de Castro JS, Torres IT, Sanchez Pulla JA, et al. Endosonography-Guided Biliary Drainage versus Percutaneous Transhepatic Biliary Drainage in the Falls of Endoscopic Retrograde  Cholangiopancreatography: Systematic Review and Meta-Analyses. J Gastroenterol Hepatol Endosc. 2021; 6(1): 1093..

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