Outcomes of EUS-guided gallbladder drainage in malignant distal biliary obstruction: a systematic review and meta-analysis

Background and aimsEUS-guided gallbladder drainage (EUS-GBD) has been described as an alternative palliative treatment for malignant distal biliary obstruction (MDBO). This study assessed the outcomes of EUS-GBD for MDBO.MethodsWe conducted a comprehensive literature review of the MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus databases. Formal meta-analysis of pooled outcomes of EUS-GBD for MDBO was performed by using a random effects model. Outcomes of interest were technical success, clinical success, adverse events, and reintervention rates. Pooled estimates were calculated following the restricted maximum likelihood method using a random effects model, and heterogeneity was assessed by using the I2 statistic.ResultsFifteen unique articles (a total of 161 patients) were included in the meta-analysis. The pooled technical success rate was 92.10% (95% confidence interval [CI], 84.70-96.09), and the pooled clinical success rate was 81.62% (95% CI, 74.27-97.24). The pooled reintervention rate after achieving clinical success was 13.02% (95% CI, 8.02-20.43), and the pooled adverse event rate was 13.81% (95% CI, 9.19-20.23). The I2 was 0 for all meta-analyses.ConclusionsThis meta-analysis is the first to evaluate outcomes of EUS-GBD in MDBO. We report high technical and clinical success with relatively low reintervention and adverse event rates. There was no heterogeneity in the data. EUS-GBD is a feasible palliative option for MDBO when conducted at experienced centers. EUS-guided gallbladder drainage (EUS-GBD) has been described as an alternative palliative treatment for malignant distal biliary obstruction (MDBO). This study assessed the outcomes of EUS-GBD for MDBO. We conducted a comprehensive literature review of the MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus databases. Formal meta-analysis of pooled outcomes of EUS-GBD for MDBO was performed by using a random effects model. Outcomes of interest were technical success, clinical success, adverse events, and reintervention rates. Pooled estimates were calculated following the restricted maximum likelihood method using a random effects model, and heterogeneity was assessed by using the I2 statistic. Fifteen unique articles (a total of 161 patients) were included in the meta-analysis. The pooled technical success rate was 92.10% (95% confidence interval [CI], 84.70-96.09), and the pooled clinical success rate was 81.62% (95% CI, 74.27-97.24). The pooled reintervention rate after achieving clinical success was 13.02% (95% CI, 8.02-20.43), and the pooled adverse event rate was 13.81% (95% CI, 9.19-20.23). The I2 was 0 for all meta-analyses. This meta-analysis is the first to evaluate outcomes of EUS-GBD in MDBO. We report high technical and clinical success with relatively low reintervention and adverse event rates. There was no heterogeneity in the data. EUS-GBD is a feasible palliative option for MDBO when conducted at experienced centers.