Is EUS-Guided Hepaticogastrostomy Safe and Effective After Failed ERCP: A Comprehensive Systematic Review and Metanalysis

Abstract

Abstract Introduction: EUS-HGS has recently emerged as an alternative option for biliary drainage in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). There is limited and variable data on safety and efficacy of EUS-HGS in the literature. In this comprehensive metanalysis, we aim to study the safety and efficacy of EUS-HGS in cases of failed conventional ERCP. Methods: Embase, PubMed, and Web of Science databases were searched to include all studies that evaluated the efficacy and safety of EUS-HGS. Using the random effect model, the pooled, weight-adjusted event rate estimate for the clinical outcomes in each group was calculated with 95% confidence intervals (CIs). The primary outcomes were technical and clinical success rate. Results: Our analysis included 70 studies with a total of 3527 patients. The pooled technical and clinical success rate for EUS-HGS were 98.1% ([95% CI, 97.5–98.7]; I2 = 40%) and 98.1% ([95% CI, 97.5–98.7]; I2 = 40%), respectively. The pooled incidence rate of total adverse events with EUS-HGS was 14.9% (95% CI, 12.7–17.1) with bile leakage being the most common (2.4% [95% CI, 1.7–3.2]). The pooled incidence of recurrent biliary obstruction (RBO) was 15.8% [95% CI, 12.2–19.4] with a high success rate for reintervention (97.5% [95% CI, 94.7–100]). Conclusion: Our analysis showed a high technical and clinical success rate of EUS-HGS making it as feasible and effective alternative to ERCP. The ongoing development of dedicated devices and techniques is expected to make EUS-HGS more accessible and safer for patients in need of biliary drainage.