Efficacy and safety of EUS‑guided biliary drainage for benign biliary obstruction – A systematic review and meta‑analysis

Background and Objectives: ERCP is the first line of treatment for benign and malignant biliary obstruction and EUS‑guided biliary drainage (EUS‑BD) is usually used for patients who have failed ERCP. Recently, several studies have evaluated the role of EUS‑BD in the management of benign biliary obstruction. This meta‑analysis evaluates the efficacy and safety of EUS‑BD in the management of benign biliary obstruction. Methods: We reviewed several databases from inception to July 8, 2022, to identify studies evaluating the efficacy and safety of EUS‑BD in the management of benign biliary obstruction. Our outcomes of interest were technical success, clinical success, and adverse events. Pooled rates with 95% confidence intervals (CIs) for all outcomes were calculated using a random effects model. Subgroup analyses were performed including patients with normal anatomy versus surgically altered anatomy (SAA). Heterogeneity was assessed by I² statistic. Results: We included 14 studies with 329 patients. The pooled rate (95% CI) of technical success was 88% (83%, 92%). The pooled rate (95% CI) of technical success for patients with SAA and normal anatomy was 92% (85%, 96%) and 83% (75%, 89%), respectively. The pooled rates (95% CI) of clinical success and adverse events were 89% (83%, 93%) and 19% (13%, 26%), respectively. We found low heterogeneity in most of the analyses. Conclusions: EUS‑BD is an effective and safe option in patients with benign biliary obstruction and should be considered after a failed attempt at ERCP or when ERCP is not technically possible.