Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2025; 17(7): 108541
Published online Jul 16, 2025. doi: 10.4253/wjge.v17.i7.108541
Evolving role of endoscopic ultrasound in biliary stricture management: A meta-analysis and systematic review
Eyad Gadour, Bogdan Miutescu, Hussein H Okasha, Mohammed Albeshir, Turki Alamri, Elsayed Ghoneem, Călin Burciu, Alexandru Popa, Oana Koppandi, Mohammed S AlQahtani
Eyad Gadour, Mohammed S AlQahtani, Multiorgan Transplant Centre of Excellence, Liver Transplantation Unit, King Fahad Specialist Hospital, Dammam 32253, Saudi Arabia
Eyad Gadour, Department of Medicine, Zamzam University College, School of Medicine, Khartoum 11113, Sudan
Bogdan Miutescu, Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
Bogdan Miutescu, Alexandru Popa, Advanced Regional Research Center in Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy, Timisoara 300041, Romania
Hussein H Okasha, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11562, Egypt
Mohammed Albeshir, Elsayed Ghoneem, Division of Gastroenterology, Department of Medicine, King Fahad Specialist Hospital, Dammam 32252, Saudi Arabia
Turki Alamri, Department of Internal Medicine, Gastroenterology Unit, King Fahad University Hospital, Al Khobar 32252, Saudi Arabia
Elsayed Ghoneem, Department of Gastroenterology and Hepatology, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
Călin Burciu, Oana Koppandi, Department of Gastroenterology, Faculty of Medicine, Pharmacy and Dental Medicine, “Vasile Goldis” West University of Arad, Arad 310414, Romania
Mohammed S AlQahtani, Department of Surgery, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
Author contributions: Gadour E, and Okasha HH contributed to conceptualization; Gadour E, Miutescu B, Okasha HH, and AlQahtani contributed to methodology; Burciu C, Popa A, and Koppandi O contributed to software; Albeshir M, Alamri T, and Ghoneem E contributed to validation; Gadour E contributed to formal analysis; Gadour E, Miutescu B , Koppandi O, and AlQahtani MS contributed to investigation; Albeshir M and Ghoneem E contributed to resources; AlQahtani MS and Okasha HH contributed to data curation; Gadour E, Alamri T, and Burciu C contributed to writing original draft preparation; Gadour E, Okasha HH, and Miutescu B contributed to writing, reviewing and editing; AlQahtani MS contributed to visualization; Okasha HH and Gadour E contributed to supervision; Gadour E and Popa A contributed to project administration; and all authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bogdan Miutescu, MD, PhD, Assistant Professor, Consultant, Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Piata Eftimie Murgu, nr. 2, Timisoara 300041, Romania. bmiutescu@yahoo.com
Received: April 17, 2025
Revised: April 23, 2025
Accepted: June 9, 2025
Published online: July 16, 2025
Processing time: 83 Days and 20 Hours
Abstract
BACKGROUND

Endoscopic ultrasound (EUS) has evolved from a diagnostic tool to a management technique for various gastroenterological conditions, including biliary strictures.

AIM

To summarize the current evidence on EUS’s role in diagnosing and managing biliary strictures.

METHODS

Two independent reviewers searched five electronic databases (PubMed, CENTRAL, Science Direct, Google Scholar, and EMBASE) for articles published up to January 2025. Included articles met specific criteria, and statistical software was used to analyze reported outcomes.

RESULTS

Of 935 articles, 19 met the inclusion criteria. Ten articles focused on diagnostic EUS, while nine focused on EUS-guided therapeutic interventions. EUS fine-needle aspiration demonstrated superior sensitivity [0.43-1.00; 95% confidence interval (CI): 0.24-1.00] compared to conventional techniques (0.36-0.96; 95%CI: 0.19-0.99) for diagnosing malignant biliary strictures. Both EUS-fine-needle aspiration and conventional methods exhibited high specificity, with most achieving 100% specificity. EUS-guided interventions showed significantly higher clinical success rates than control interventions (odds ratio = 2.89; 95%CI: 1.22-6.84; P = 0.02). No significant difference was observed in technical success rates (odds ratio = 0.97; 95%CI: 0.30-3.16; P = 0.96).

CONCLUSION

EUS is a promising tool for diagnosing and managing biliary strictures. Combining EUS-guided and conventional interventions improves diagnostic performance. Further research is needed to investigate the feasibility and use of EUS-guided interventions in this field.

Keywords: Endoscopic ultrasound; Biliary strictures; Endoscopic ultrasound guided fine-needle aspiration; Systematic review; Clinical success rate

Core Tip: Endoscopic ultrasound (EUS) has emerged as a valuable tool for diagnosing and managing biliary strictures. This systematic review and meta-analysis found that EUS-guided fine-needle aspiration is superior to conventional techniques for diagnosing malignant biliary strictures, with higher sensitivity while maintaining high specificity. For management, EUS-guided interventions showed significantly higher clinical success rates compared to conventional methods, though technical success rates were similar. EUS-guided biliary drainage and stenting appear promising for cases where endoscopic retrograde cholangiopancreatography fails. However, more research is needed on the efficacy of various EUS-guided therapies for biliary strictures. Overall, EUS demonstrates an expanding and important role in biliary stricture diagnosis and treatment.