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Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard in managing malignant biliary obstruction. The success of ERCP has limitations, whereas surgical biliary bypass and percutaneous transhepatic approaches, as alternative modalities, come with significant costs, longer durations, and higher levels of mortality and morbidity. Endoscopic ultrasonography (EUS)‐guided biliary drainage with two approaches, hepaticogastrostomy (EUS‐HGS) and choledochoduodenostomy (EUS‐CDS), is a favored and evolving alternative modality. This study aims to compare the efficacy and safety of EUS‐HGS and EUS‐CDS. We conducted a systematic review and meta‐analysis by searching PubMed, ScienceDirect, Cochrane Library, and Scholar databases up to August 2023, based on the 2020 PRISMA guidelines. We identified randomized and nonrandomized studies comparing the efficacy and safety of EUS‐HGS and EUS‐CDS. Outcome measures included technical and clinical success, side effects, and mean procedure time. Nine nonrandomized studies and two randomized controlled trials involving 537 patients (225 EUS‐HGS, 312 EUS‐CDS) were analyzed. No difference was found in technical success (OR, 0.83; 95% CI, 0.41–1.68; I2 = 0%) and clinical success between the two procedures (OR, 0.96; 95% CI, 0.51–1.81; I2 = 9.94%). Side effects were significantly higher in EUS‐HGS (OR, 2.01, 95% CI, 1.14–3.59; I2 = 0%). No significant difference in mean procedure time was observed between the two procedures (0.13; 95% CI, −0.15–0.41; I2 = 34.89%). There are differences in efficacy and safety between EUS‐HGS and EUS‐CDS. EUS‐CDS has a faster procedure time, lower risk of side effects, and ease of puncture during the procedure. [ABSTRACT FROM AUTHOR]

Abstract Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard in managing malignant biliary obstruction. The success of ERCP has limitations, whereas surgical biliary bypass and percutaneous transhepatic approaches, as alternative modalities, come with significant costs, longer durations, and higher levels of mortality and morbidity. Endoscopic ultrasonography (EUS)‐guided biliary drainage with two approaches, hepaticogastrostomy (EUS‐HGS) and choledochoduodenostomy (EUS‐CDS), is a favored and evolving alternative modality. This study aims to compare the efficacy and safety of EUS‐HGS and EUS‐CDS. We conducted a systematic review and meta‐analysis by searching PubMed, ScienceDirect, Cochrane Library, and Scholar databases up to August 2023, based on the 2020 PRISMA guidelines. We identified randomized and nonrandomized studies comparing the efficacy and safety of EUS‐HGS and EUS‐CDS. Outcome measures included technical and clinical success, side effects, and mean procedure time. Nine nonrandomized studies and two randomized controlled trials involving 537 patients (225 EUS‐HGS, 312 EUS‐CDS) were analyzed. No difference was found in technical success (OR, 0.83; 95% CI, 0.41–1.68; I2 = 0%) and clinical success between the two procedures (OR, 0.96; 95% CI, 0.51–1.81; I2 = 9.94%). Side effects were significantly higher in EUS‐HGS (OR, 2.01, 95% CI, 1.14–3.59; I2 = 0%). No significant difference in mean procedure time was observed between the two procedures (0.13; 95% CI, −0.15–0.41; I2 = 34.89%). There are differences in efficacy and safety between EUS‐HGS and EUS‐CDS. EUS‐CDS has a faster procedure time, lower risk of side effects, and ease of puncture during the procedure.

Background: Endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced (ECE) delivery of lumen-apposing metal stent (LAMS) is gradually being recognized as a viable palliative technique for malignant biliary obstruction after endoscopic retrograde cholangiopancreatography (ERCP) failure. However, most of the studies that have assessed its efficacy and safety were small and heterogeneous. Prior meta-analyses of six or fewer studies that were published 2 years ago were therefore underpowered to yield convincing evidence., Aim: To update the efficacy and safety of ECE-LAMS for treatment of biliary obstruction after ERCP failure., Methods: We searched PubMed, EMBASE, and Scopus databases from the inception of the ECE technique to May 13, 2022. Primary outcome measure was pooled technical success rate, and secondary outcomes were pooled rates of clinical success, reintervention, and adverse events. Meta-analysis was performed using a random-effects model following Freeman-Tukey double-arcsine transformation in R software (version 4.1.3)., Results: Fourteen eligible studies involving 620 participants were ultimately included. The pooled rate of technical success was 96.7%, and clinical success was 91.0%. Adverse events were reported in 17.5% of patients. Overall reintervention rate was 7.3%. Subgroup analyses showed results were generally consistent., Conclusion: ECE-LAMS has favorable success with acceptable adverse events in relieving biliary obstruction when ERCP is impossible. The consistency of results across most subgroups suggested that this is a generalizable approach., Competing Interests: Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: This study was performed to compare the outcomes of laparoscopic common bile duct exploration (LCBDE) after failed endoscopic retrograde cholangiopancreatography (ERCP) versus primary LCBDE for managing cholecystocholedocholithiasis., Methods: We retrospectively analyzed data from 59 patients who underwent LCBDE during laparoscopic cholecystectomy (LC) for managing cholecystocholedocholithiasis from January 2013 to August 2019. The patients underwent either primary LCBDE plus LC (Group I) or LCBDE plus LC after failed ERCP (Group II). The demographics, reason for ERCP failure, perioperative details, and postoperative outcomes were evaluated., Results: CBD stone removal using preoperative ERCP failed in 31 patients (Group II) because of remaining stones after ERCP (n = 9), failed cannulation (n = 6), failed sedation (n = 6), a periampullary diverticulum (n = 5), previous Billroth II gastrectomy (n = 3), a huge stone (n = 1), and an impacted stone (n = 1). The CBD stone clearance rate was >96% in both groups. The mean operative time, hospital stay, overall complication rate, and open conversion rate were not significantly different between the two groups., Conclusions: When extraction of CBD stones by ERCP is likely to be difficult or fail, primary LCBDE is an acceptable alternative treatment for managing cholecystocholedocholithiasis.