Clinical Endoscopy

Systematic Review and Meta-analysises

Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials: Yousaf Zafar, Hafsa Azam, Muhammad Abdullah Bin Azhar, Fabeeha Shaheen, Syed Sarmad Javaid, Laila Manzoor, Muaaz Masood, Rajesh Krishnamoorthi; Clin Endosc 2025;58(4):533-543. Published online February 24, 2025; DOI: https://doi.org/10.5946/ce.2024.183

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Background
/Aims: Malignant biliary obstruction is a major clinical challenge. We assessed the efficacy of endoscopic ultrasound-guided biliary drainage (EUS-BD) compared with that of endoscopic retrograde cholangiopancreatography biliary drainage (ERCP-BD) or percutaneous transhepatic biliary drainage (PTBD).
Methods
We searched for randomized controlled trials comparing EUS-BD with ERCP or PTBD in treating malignant biliary obstruction. Using random-effects models, we synthesized risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs). A subgroup analysis was performed using a comparator (ERCP or PTBD).
Results
EUS-BD significantly reduced the risk of stent dysfunction (RR, 0.46; 95% CI, 0.33–0.64), with consistent results in subgroup analysis for ERCP (RR, 0.54; 95% CI, 0.35–0.84) and PTBD (RR, 0.37; 95% CI, 0.22–0.61). It also lowered the risk of post-procedure pancreatitis (RR, 0.24; 95% CI, 0.07–0.83) and reduced tumor ingrowth or overgrowth risk (RR, 0.27; 95% CI, 0.11–0.65), even when compared to ERCP alone (RR, 0.28; 95% CI, 0.11–0.70). EUS-BD demonstrated a lower risk of adverse events compared to PTBD (RR, 0.37; 95% CI, 0.14–0.97) and reduced length of hospital stay (WMD, –1.03; 95% CI, –1.53 to –0.53) when compared to ERCP.
Conclusions
EUS-BD outperformed ERCP-BD and PTBD in reducing stent dysfunction, postprocedural pancreatitis, and tumor ingrowth or overgrowth.

Citations

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Joan B. Gornals, Albert Sumalla-Garcia, Carme Loras
Clinical Gastroenterology and Hepatology.2026; 24(4): 1203. CrossRef
Biliary Drainage in Altered Anatomy: A Comprehensive Literature Review
Rishi Chowdhary, Jorge D. Machicado, Veeral M. Oza
Journal of Digestive Endoscopy.2026;[Epub] CrossRef
A Time-Based and Clinical Status Stratified Protocol for Major Bile Duct Injury After Cholecystectomy: Retrospective, Single-Center Outcomes From a Resource-Limited Setting
Ahmed Ateik, Saif A Ghabisha, Lamia Abdulmughni, Fares Awn
Cureus.2026;[Epub] CrossRef
Biliary Drainage During Neoadjuvant Chemotherapy in Pancreatic Cancer: Evidence and Practical Recommendations
Tadahisa Inoue, Masanao Nakamura, Kiyoaki Ito
Cancers.2026; 18(3): 467. CrossRef
Endoscopic Ultrasound-Guided Versus Percutaneous Transhepatic Biliary Drainage After Failed Endoscopic Retrograde Cholangiopancreatography in Malignant Biliary Obstruction: A Single-Center Retrospective Cohort
Wojciech Ciesielski, Łukasz Durko, Ludomir Stefańczyk, Adam Dobek, Anna Bulicz, Amelia Wojnicka, Zuzanna Sosnowska, Agata Grochowska, Janusz Strzelczyk, Piotr Hogendorf, Adam Durczyński, Tomasz Klimczak
Cancers.2026; 18(5): 783. CrossRef
Role of Endoscopy in Malignant Biliary Obstruction
Ishaan Vohra, Burraq Imran, Zubair Khan, Muhammad Hasan
Diagnostics.2026; 16(5): 721. CrossRef
Case Report: Unexpected LAMS obstruction following successful EUS-BD in a patient with pancreatic carcinoma
Xuxia He, Kun He, Qiang Wang
Frontiers in Surgery.2026;[Epub] CrossRef
EUS-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed ERCP in oncological patients: a 10-year retrospective comparison
P Alves, L Lenz, C Clemente, I Kristal, M Beltrami, AD P Gustavo, B Costa Martins, A Safatle-Ribeiro, F Maluf-Filho
Endoscopy.2026; 58(S 03): S634. CrossRef
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Joan B. Gornals, Manuel Perez-Miranda, Carme Loras
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Use of abdominal compression device in colonoscopy: a systematic review and meta-analysis: Yousaf Zafar, Ahmed Mustafa Rashid, Syed Sarmad Javaid, Ahmed Kamal Siddiqi, Adnan Zafar, Arsalan Zafar Iqbal, Jagpal Singh Klair, Rajesh Krishnamoorthi; Clin Endosc 2023;56(4):446-452. Published online May 26, 2023; DOI: https://doi.org/10.5946/ce.2022.304

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Colonoscopy for screening is associated with unpleasant experiences for patients, and abdominal compression devices have been developed to minimize these problems. However, there is a paucity of data supporting the therapeutic benefits of this strategy. This study examined the effects of using an abdominal compression device during colonoscopy on the cecal intubation time (CIT), abdominal compression, patient comfort, and postural changes.
Methods
We searched PubMed and Scopus (from inception to November 2021) for randomized controlled trials that assessed the effects of an abdominal compression device during colonoscopy on CIT, abdominal compression, patient comfort, and postural change. A random-effects meta-analysis was performed. Weighted mean differences (WMDs) and Mantel-Haenszel odds ratios (ORs) were calculated.
Results
Our pooled analysis of seven randomized controlled trials revealed that abdominal compression devices significantly reduced CIT (WMD, –0.76 [–1.49 to –0.03] minutes; p=0.04), abdominal compression (OR, 0.52; 95% confidence interval [CI], 0.28–0.94; p=0.03), and postural changes (OR, 0.46; 95% CI, 0.27–0.78; p=0.004) during colonoscopy. However, our results did not show a significant change in patient comfort (WMD, –0.48; 95% CI, –1.05 to 0.08; p=0.09) when using an abdominal compression device.
Conclusions
Our findings demonstrate that employing an abdominal compression device may reduce CIT, abdominal compression, and postural change but have no impact on patient comfort.

Citations

Citations to this article as recorded by

Optimizing colonoscopy with abdominal compression devices: an updated meta-analysis of randomized controlled trials
Abdallfatah Abdallfatah, Mohamed A. Aldemerdash, Ahmed W. Hageen, Samaa Daoud, Mahmoud Elbaklish, Mohammed Hassan Morsy, Ahmed R. A. Abou-Shanab, Islam Mohamed, Hazem Abosheaishaa
Baylor University Medical Center Proceedings.2026; 39(1): 96. CrossRef
Abdominal binders improve colonoscopy outcomes: a systematic review and meta-analysis of randomized controlled trials with BMI-stratified subgroup analysis
Yu-Kuang Kang, Tien-Yu Huang, Meng-Chuan Lu, Peng-Jen Chen, Po-Feng Huang
Therapeutic Advances in Gastroenterology.2026;[Epub] CrossRef
Evidence-Based Foundations and Training Implementation of Standardized Colonoscope Insertion Protocols
灵灵
Advances in Clinical Medicine.2026; 16(08): 600. CrossRef
Use of an abdominal binder in colonoscopies performed by trainees in gastrointestinal endoscopy: a randomized, double-blind, sham-controlled trial
Antonio Marmolejo, Sinue Cázarez, Carlos J. Mata, Sergio Ayala, Jorge Farell, Nubia A. Ramírez, Carlos A. Navarro Castañeda, Luis García
Surgical Endoscopy.2025; 39(5): 3236. CrossRef
Terminal ileum in screening colonoscopy: routine practice or risk-stratified approach?
Seong-Jung Kim
Clinical Endoscopy.2025; 58(5): 696. CrossRef

7,713 View
153 Download
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