A63 EUS-GUIDED BILIARY DRAINAGE FOR DECOMPRESSION OF MALIGNANT BILIARY OBSTRUCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
Endoscopic ultrasound (EUS)-guided biliary drainage (BD) is increasingly used for malignant distal biliary obstruction, yet its safety and efficacy are not well established, especially as a first-line modality when compared to endoscopic retrograde cholangiopancreatography (ERCP). To conduct a systematic review and meta-analysis to determine the safety and efficacy of EUS-BD for the treatment of malignant biliary obstruction. The literature was systematically searched through September 2018, querying Embase, MEDLINE, CENTRAL and ISI Web of Knowledge. All abstracts and fully-published randomized controlled trials (RCTs) that compared EUS-BD to another modality for decompression of malignant biliary obstruction were included. A meta-analysis was conducted with results reported as risk ratios (RRs) with 95% confidence intervals (CIs) using a random effects model. The primary outcome of interest was comparative risk of reintervention. Prespecified subgroup analysis by comparator was performed. Initial search yielded 1264 papers. Following review, 8 trials (2 abstracts) are included that randomized 406 patients to either EUS-BD as primary treatment vs. ERCP (3 studies, n=220) or EUS-BD as rescue therapy vs. percutaneous transhepatic biliary drainage (PTBD) (3 trials, n=132) or surgery (2 trials, n=52). Overall, EUS-BD is associated with a decreased risk for reintervention (RR, 0.48; 95% CI, 0.32–0.71). On subgroup analysis, reintervention rates also favoured EUS-BD over ERCP (RR, 0.40; 95% CI, 0.23–0.71) and PTBD (RR, 0.49, 95% CI, 0.28–0.88). In addition, compared to ERCP, EUS-BD is associated with decreased risk for stent dysfunction (RR, 0.52; 95% CI 0.29–0.94), tumour in/overgrowth (RR, 0.18; 95% CI, 0.05–0.69) and post-procedure pancreatitis (RR, 0.12; 95% CI, 0.01–0.97). There is decreased risk of adverse events compared to PTBD (RR, 0.59; 95% CI, 0.39–0.87) but no difference was observed overall. No difference was noted in technical/clinical success overall or in the subgroup analyses. No significant heterogeneity or publication bias was noted. In a meta-analysis of RCTs, EUS-BD is associated with similar technical/clinical success as other drainage modalities including ERCP. It is, however, associated with decreased risk for reintervention, stent tumor in/overgrowth, and post-procedure pancreatitis, suggesting a promising role as a first-line modality for malignant distal biliary obstruction. None
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.008 | 0.004 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".