Endoscopic ultrasound‐guided hepaticogastrostomy versus choledochoduodenostomy for malignant biliary obstruction: A meta‐analysis

OBJECTIVES: Endoscopic ultrasound (EUS)‐guided biliary drainage encompasses techniques such as EUS‐guided hepaticogastrostomy (EUS‐HGS) and EUS‐guided choledochoduodenostomy (EUS‐CDS). This meta‐analysis compared the efficacy of EUS‐CDS with that of EUS‐HGS for the treatment of biliary obstruction. METHODS: A systematic meta‐analysis of all relevant articles listed was performed by searching the Cochrane Library, PubMed, and Google Scholar databases. We used random effects or fixed effects models to compare success rates, adverse events, procedure times, and time to recurrent biliary obstruction after EUS‐CDS and EUS‐HGS. RESULTS: This meta‐analysis included 18 eligible studies. There was no significant difference between EUS‐CDS and EUS‐HGS with respect to technical success rate (odds ratio [OR] 1.04; 95% confidence interval [CI] 0.62–1.73) and clinical success rate (OR 0.66; 95% CI 0.43–1.04), or with respect to total procedure‐related adverse events (OR 1.39; 95% CI 1.00–1.93). Subgroup analysis of adverse events revealed that the rate of recurrent biliary obstruction (RBO) was significantly higher for EUS‐HGS (OR 2.95; 95% CI 1.54–5.64). There was no significant difference between the two methods with respect to time to recurrent biliary obstruction (mean difference –11.93 days; 95% CI –47.77–23.91). However, the procedure time was longer for EUS‐HGS (mean difference, 3.21 min; 95% CI 1.24–5.19). CONCLUSION: EUS‐CDS and EUS‐HGS are comparable in terms of technical success, clinical success, and rate of adverse events; however, EUS‐CDS is superior with respect to procedure time and preventing RBO.