Evidence map›Paper›PMID 41584023›Full record

ArticleEndoscopic ultrasound

Comparison of 4 first-line endoscopic biliary drainage modalities in distal malignant biliary obstruction: A systematic review and network meta-analysis.

Gunn Huh, Won-Mook Choi, Jung Bok Lee, John J Vargo, Sunguk Jang, Taehyung Lee, Ce Hwan Park, Steven A Edmundowicz, Do Hyun Park

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Endoscopic ultrasound. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Gunn HuhDivision of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Won-Mook ChoiDivision of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Jung Bok LeeDepartment of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
John J VargoDepartment of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Sunguk JangDepartment of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Taehyung LeeDepartment of Internal Medicine, Asan Medical Center, Seoul, South Korea.
Ce Hwan ParkDepartment of Internal Medicine, Asan Medical Center, Seoul, South Korea.
Steven A EdmundowiczDivision of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Do Hyun ParkDivision of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background and objectives: EUS-guided biliary drainage is a potential alternative to endoscopic retrograde cholangiopancreatography (ERCP) for distal malignant biliary obstruction (DMBO). However, its role as a primary intervention remains uncertain. This study compares the clinical outcomes of 4 primary endoscopic drainage modalities: ERCP, EUS-hepaticogastrostomy (HGS), EUS-choledochoduodenostomy (CDS) with lumen-apposing metal stent (LAMS), and EUS-CDS with self-expandable metal stents (SEMSs). Methods: The literature was searched up until July 2024. A network meta-analysis of 5 randomized controlled trials and 3 comparative studies, including 796 patients (444 ERCP, 180 EUS-CDS-LAMS, 116 EUS-CDS-SEMS, 56 EUS-HGS), was conducted. Outcomes assessed included clinical success, technical success, procedural time, adverse events, reintervention rates, and stent patency. Results: Clinical success was comparable across all modalities. EUS-CDS-LAMS demonstrated higher technical success compared with ERCP (odds ratio [OR], 3.95; 95% confidence interval [CI], 1.54-10.12) and EUS-CDS-SEMS (OR, 4.37; 95% CI, 1.03-18.55). EUS-CDS-LAMS also had a shorter procedural time compared with ERCP (standardized mean difference, -11.67; 95% CI, -15.66 to -7.68), EUS-CDS-SEMS, and EUS-HGS. Adverse event rates were similar across all groups. EUS-HGS had fewer reinterventions compared with ERCP (OR, 0.20; 95% CI, 0.08-0.52) and EUS-CDS-LAMS (OR, 0.22; 95% CI, 0.07-0.74). At 6 months, stent patency rates were 88.7% for EUS-HGS, 84.5% for EUS-CDS-SEMS, 73.1% for EUS-CDS-LAMS, and 64.8% for ERCP. Conclusions: Clinical success and adverse event rates were comparable among modalities. EUS-CDS-LAMS showed superior technical success and shorter procedural time. In contrast, EUS-HGS showed fewer reinterventions and better stent patency than ERCP.

Indexed as

Distal malignant biliary obstructionEndoscopic retrograde cholangiopancreatographyEUSLumen apposing metal stent

Identifiers

PMID41584023
PMCPMC12829709

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.