P4459 - Endoscopic Ultrasound-Guided Biliary Drainage for Acute Cholangitis Secondary to Biliary Obstruction: A Systematic Review and Meta-Analysis

Yash Shah, MD¹, Sahib Singh, MD², Dushyant S. Dahiya, MD³, Ernesto Calderon-Martinez, MD⁴, Manesh Kumar Gangwani, MD⁵, Saurabh Chandan, MD⁶, Charmy Parikh, MD⁷, Mihir P. Shah, MD⁸, Babu Mohan, MD⁹, Rashmi Advani, MD^10
1Trinity Health Oakland / Wayne State University School of Medicine, Pontiac, MI; ²Sinai Hospital, Baltimore, MD; ³The University of Kansas School of Medicine, Kansas City, KS; ⁴University of Texas at Houston, Houston, TX; ⁵University of Toledo, Toledo, OH; ⁶CHI Health Creighton University Medical Center, Omaha, NE; ⁷Mercy Catholic Medical Center, Darby, PA; ⁸John H. Stroger, Jr. Hospital of Cook County, Cook County, IL; ⁹Orlando Gastroenterology PA, Orlando, FL; ¹⁰Mount Sinai South Nassau, Icahn School of Medicine at Mount Sinai, Oceanside, NY

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) remains the primary treatment for biliary obstruction, yet fails in 5-7% of cases, necessitating alternative therapeutic options like endoscopic ultrasound guided-biliary drainage (EUS-BD). With acute cholangitis posing significant morbidity and mortality risks, assessing the safety and efficacy of EUS-BD in these patients is vital. This meta-analysis with a subgroup analysis aims to assess the outcomes of EUS-BD in patients with acute cholangitis secondary to biliary obstruction.



Methods: A systematic review and meta-analysis was conducted following PRISMA 2020 guidelines, searching MEDLINE, Embase, Web of Science, Clinicaltrials.gov, and Cochrane databases until December 23, 2023. Studies involving adult patients undergoing EUS-BD for cholangitis were included. Outcomes assessed were pooled technical and clinical success rates, complications, and mortality. Analysis was performed using the random-effects model, and heterogeneity was assessed using the I2% statistics.



Results: Among the included five studies (109 patients), EUS-BD achieved a pooled technical success rate of 95.5% (95%CI 91.0-98.5, I2:0.00%) and clinical success rate of 92.1% (95%CI 86.4-96.3, I2:0.00%), with low heterogeneity across studies. The pooled complication rate was 12.2% (95% CI: 5.1-21.8, I2: 37.46%), with predominantly mild and self-limiting complications. The post procedure mortality was 0%, however, 30 day pooled mortality rate was 21.6% (95%CI 1.6-55.3, I2:86.24%). EUS-HGS was the most commonly performed procedure across all the studies with a total of 73 patients out of 109 undergoing EUS-HGS. EUS-HGS demonstrated high technical success of 95.1% (95%CI 89.2-98.7, I2:0.00%) and favorable clinical success of 89.4% (95%CI 79.4-96.3, I2: 27.1%). It displayed a slightly higher rate of complicaitons 16.5% (95%CI 5.5-31.9, I2:37.05%).



Discussion: ERCP is the gold standard for biliary drainage however, it can be technically challenging in cases with duodenal infiltration, inaccessible papilla, distorted anatomy. EUS-BD demonstrated excellent pooled technical and clinical success rates, in patients with acute cholangitis secondary to biliary obstruction. Most post-procedure complication rates are also mild and self limiting making EUS-BD a possible alternative for management of cholangitis. The 30-day mortality was higher than post-procedure mortality of 0%, reflecting the complex and severe nature of underlying etiologies leading to cholangitis.




Disclosures:


Yash Shah, MD¹, Sahib Singh, MD², Dushyant S. Dahiya, MD³, Ernesto Calderon-Martinez, MD⁴, Manesh Kumar Gangwani, MD⁵, Saurabh Chandan, MD⁶, Charmy Parikh, MD⁷, Mihir P. Shah, MD⁸, Babu Mohan, MD⁹, Rashmi Advani, MD¹⁰. P4459 - Endoscopic Ultrasound-Guided Biliary Drainage for Acute Cholangitis Secondary to Biliary Obstruction: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.