Adverse events with EUS-guided biliary drainage: a systematic review and meta-analysis

• Published in: Gastrointestinal endoscopy Vol. 98; no. 4; pp. 515 - 523.e18
• Main Authors: Giri, Suprabhat, Mohan, Babu P., Jearth, Vaneet, Kale, Aditya, Angadi, Sumaswi, Afzalpurkar, Shivaraj, Harindranath, Sidharth, Sundaram, Sridhar
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-10-2023
• Subjects: BD; CDS; AE; HGS; CI; LAMS; SEMS
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2023.06.055

Multiple meta-analyses have evaluated the technical and clinical success of EUS-guided biliary drainage (BD), but meta-analyses concerning adverse events (AEs) are limited. The present meta-analysis analyzed AEs associated with various types of EUS-BD.
A literature search of MEDLINE, Embase, and Scopus was conducted from 2005 to September 2022 for studies analyzing the outcome of EUS-BD. The primary outcomes were incidence of overall AEs, major AEs, procedure-related mortality, and reintervention. The event rates were pooled using a random-effects model.
One hundred fifty-five studies (7887 patients) were included in the final analysis. The pooled clinical success rates and incidence of AEs with EUS-BD were 95% (95% confidence interval [CI], 94.1-95.9) and 13.7% (95% CI, 12.3-15.0), respectively. Among early AEs, bile leak was the most common followed by cholangitis with pooled incidences of 2.2% (95% CI, 1.8-2.7) and 1.0% (95% CI, .8-1.3), respectively. The pooled incidences of major AEs and procedure-related mortality with EUS-BD were .6% (95% CI, .3-.9) and .1% (95% CI, .0-.4), respectively. The pooled incidences of delayed migration and stent occlusion were 1.7% (95% CI, 1.1-2.3) and 11.0% (95% CI, 9.3-12.8), respectively. The pooled event rate for reintervention (for stent migration or occlusion) after EUS-BD was 16.2% (95% CI, 14.0-18.3; I2 = 77.5%).
Despite a high clinical success rate, EUS-BD may be associated with AEs in one-seventh of the cases. However, major AEs and mortality incidence remain less than 1%, which is reassuring.
[Display omitted]