Efficacy and Safety of Endoscopic Ultrasound-Guided Biliary Drainage: A Systematic Review and Meta-analysis: Presidential Poster
Bibliographic record
Abstract
Introduction: Endoscopic retrograde cholangiography (ERC) with stent placement is the procedure of choice for relief of biliary obstruction. In 10% cases ERC fails and such patients undergo percutaneous transhepatic biliary drainage (PTBD) or surgical bypass. However, these procedures are associated with substantial morbidity and/or mortality. Endoscopic ultrasound guided biliary drainage (EUS-BD) is a relatively new therapeutic modality for attaining satisfactory biliary drainage when traditional ERC fails. We aimed to conduct a meta-analysis evaluating the cumulative efficacy and safety of EUS-BD.Figure 1Figure 2Figure 3Methods: We searched Medline, EMBASE, Cochrane database, ISI Web of Science and Scopus from January 1, 2001 through March 31, 2015, to identify studies reporting technical success and postprocedure adverse events of EUS-BD. A sample size of more than 20 patients was a further criterion. Weighted pooled rates (WPR) for technical success and post-procedure complications were calculated for overall studies and predefined subgroups based on quality of studies. These were analyzed using the random or fixed effects model for meta-analysis based on heterogeneity. Newcastle Ottawa Scale was used for observational studies and Jadad scale was used for randomized controlled trial to assess quality of studies. Results: A total of 20 studies were included in the analysis to evaluate the efficacy and safety of EUS-BD. The WPR with 95% confidence interval (CI) for technical success and post-procedure adverse events were 90% (86%, 93%) and 17% (13%, 22%) respectively with considerable heterogeneity (I2=77%). For high quality studies, the WPR for technical success was 94% (92%, 96%), with no heterogeneity (I2=0%) and WPR for post-procedure adverse event was 13% (10%, 16%), with low heterogeneity, (I2=39%). Overall, WPR for clinical success was 95% (93%, 97%) with no heterogeneity (I=22%). Conclusion: In the light of our meta-analysis, EUS-BD appears to be a very good alternative option for therapeutic and palliative biliary drainage in cases where ERC fails. Currently the procedure is under evolution and is being conducted at expert endoscopy centers. Consortium meetings are held every year to discuss the progress of EUS-BD. In future randomized control trials are required to further evaluate the efficacy and safety of procedure along with comparison to traditional modalities like PTBD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.032 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.041 |
| Bibliometrics | 0.008 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 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 source (direct Gemma or distilled Codex), 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".