EUS-guided gallbladder drainage as a rescue in distal malignant biliary obstruction: A systematic review with meta-analysis
Bibliographic record
Abstract
Abstract Patients with distal malignant biliary obstruction (dMBO) needing biliary drainage (BD) undergo ERCP as a first approach. EUS–guided gallbladder drainage (EUS-GBD) is now accepted as a rescue alternative for the palliation of jaundice in those patients with dMBO who fail ERCP and cannot undergo EUS-BD. This is a systematic review with meta-analysis for evaluating the efficacy and safety of EUS-GBD in this scenario. A comprehensive search through the main database platforms was conducted to May 2024. Pooled estimates were obtained using a fixed-effects model with the generic inverse variance method. Study quality was evaluated using the Newcastle-Ottawa quality assessment scale (NOS). Heterogeneity was evaluated with I 2 statistic. Clinical success, adverse events (AEs) rate, and reintervention rate were the main outcomes. Sensitivity analyses were also conducted. Eight studies including 183 patients were identified. Pooled clinical success was 89% (95% CI, 84%–93%). The pooled clinical success of full-text publication was 88% (95% CI, 83%–93%; I 2 = 0%). Reintervention rate was 8% (95% CI, 4%–12%; I 2 = 0%). The overall AE rate was 10% (95% CI, 6%–15%; I 2 = 0%). The NOS allocated moderate quality in 7 studies. In conclusion, our findings confirm that EUS-GBD in dMBO is a feasible, effective, and safe technique as rescue therapy after failure of ERCP or EUS-BD.
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.014 | 0.004 |
| Bibliometrics | 0.001 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".