Percutaneous transhepatic cholangiography endoscopic ultrasound-guided biliary drainage: A systematic review.

Background: Percutaneous transhepatic cholangiography is a diagnostic and therapeutic procedure that involves inserting a needle into the biliary tree, followed by the immediate insertion of a catheter. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a novel technique that allows BD by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal tract.

Aim: To compare the technical aspects and outcomes of percutaneous transhepatic BD (PTBD) and EUS-BD.

Methods: Different databases, including PubMed, Embase, clinicaltrials.gov, the Cochrane library, Scopus, and Google Scholar, were searched according to the guidelines for Preferred Reporting Items for Systematic reviews and Meta-Analyses to obtain studies comparing PTBD and EUS-BD.

Results: Among the six studies that fulfilled the inclusion criteria, PTBD patients underwent significantly more reinterventions (4.9 1.3), experienced more postprocedural pain (4.1 1.9), and experienced more late adverse events (53.8% 6.6%) than EUS-BD patients. There was a significant reduction in the total bilirubin levels in both the groups (16.4-3.3 μmol/L and 17.2-3.8 μmol/L for EUS-BD and PTBD, respectively; = 0.002) at the 7-d follow-up. There were no significant differences observed in the complication rates between PTBD and EUS-BD (3.3 3.8). PTBD was associated with a higher adverse event rate than EUS-BD in all the procedures, including reinterventions (80.4% 15.7%, respectively) and a higher index procedure (39.2% 18.2%, respectively).

Conclusion: The findings of this systematic review revealed that EUS-BD is linked with a higher rate of effective BD and a more manageable procedure-related adverse event profile than PTBD. These findings highlight the evidence for successful EUS-BD implementation.