Evolving role of endoscopic ultrasound in biliary stricture management: A meta-analysis and systematic review

Table 1 Characteristics of included diagnostic test accuracy studies

Ref.	Study design	Location of lesion	Sample size	Inclusion criteria	Diagnostic intervention	Gold standard	Findings	Center type
Novis et al, 2010[9]	Comparative study	Distal	46	Biliary obstruction	EUS-FNA and ERCP	Histology, surgery, and follow-up	Benign lesions (n = 7) and malignant lesions (n = 37)	SC
Fritscher-Ravens et al, 2004[10]	Prospective	Proximal	44	Patients with obstructive jaundice and a clinical suspicion of cancer	EUS-FNA	Autopsy, surgery, or follow-up	Benign (n = 12) and malignant (n = 31)	SC
Ohshima et al, 2011[11]	Prospective	Biliary	22	Patients with suspected malignant biliary strictures	EUS-FNA	Histology, surgery, and follow-up	Malignant (n = 16) and benign (n = 6)	SC
Weilert et al, 2014[12]	Prospective	Biliary	51	Patients with suspected pancreaticobiliary pathologies	EUS-FNA and ERCP	Surgery, definitive findings, and follow-up	Benign (n = 3) and malignant (n = 48)	SC
DeWitt et al, 2006[13]	Prospective	Proximal	24	Patients with suspected or confirmed proximal biliary strictures	EUS-FNA	Surgical pathology findings and follow-up	Malignant (n = 17) and benign (n = 7)	SC
Eloubeidi et al, 2004[17]	Prospective	Biliary	25	Patients with common bile duct strictures	EUS-FNA	Follow-up and surgical pathology	Malignant (n = 31) and benign (n = 7)	SC
Rösch et al, 2004[14]	Prospective	Biliary	50	Patients with indeterminate biliary strictures	EUS-FNA and ERCP	Follow-up and surgical pathology or other biopsy results	Malignant (n = 28) and benign (n = 22)	SC
Lee et al, 2019[15]	Prospective	Distal	181	Patients with suspected malignant biliary strictures	EUS-FNA, ERCP, and POC-FB	Surgical pathology findings and malignant diagnosis after biopsy or during follow-up	Malignant (n = 51) and benign (n = 8)	MC
Yeo et al, 2019[16]	Retrospective	Biliary	93	Patients with suspected biliary strictures	EUS-TS and ERCP-TS	Histopathology findings based on the surgical specimen, cytology findings of either EUS-TS or ERCP-TS, or during clinical follow-up	Malignant (n = 70) and benign (n = 16)	MC
Lee et al, 2017[18]	Prospective	Biliary	178	Patients with suspected malignant biliary strictures	ERCP with TPB and EUS-FNA	Histopathologic findings of the surgical specimens, diagnosis based on TPB or EUS-FNAB, or during the clinical imaging on follow-up	Malignant (n = 171) and benign (n = 7)	MC

EUS: Endoscopic ultrasound; FNA: Fine-needle aspiration; CI: Confidence interval; ERCP: Endoscopic retrograde cholangiopancreatography; SC: Surgical control; POC-FB: Peroral cholangioscopy with forceps biopsy; TS: Technical success; TPB: Transpapillary biopsy; FNAB: Fine needle aspiration biopsy; MC: Multi-center.

Table 2 Characteristics of the included interventional studies

Ref.	Study design	Study setting	Study group	Sample size	Mean age (years)	Inclusion criteria	Reported outcomes	Center type
Bang et al, 2018[19]	RCT	United States	EUS-BD	33	69.4 ± 12.6	Patients with obstructive jaundice and a pancreatic head mass	Rate of adverse events, technical success, treatment success, re-interventions, and procedural duration	MC
Paik et al, 2018[20]	RCT	South Korea	EUS-BD	64	64.8	Adult patients with unresectable malignant biliary strictures	Technical success rates, clinical success rates, median hospital stay, and early adverse events	MC
Sharaiha et al, 2016[21]	Retrospective case-control study	United States	EUS-BD	47	-	Patients with either malignant or benign biliary obstruction	Technical and clinical success, post-procedural pain, and incidence of adverse events	SC
Bapaye et al, 2013[22]	Retrospective case-control study	India	EUS-BD	25	59.9 ± 13.3	Patients with unresectable malignancies causing biliary obstruction	Successful stent placement and incidence of complications	SC
Huang et al, 2017[23]	Retrospective case-control study	China	EUS-BD	36	68 ± 4.62	Patients with failed ERCP for the management of obstructive jaundice secondary to malignancy	Technical and clinical success rates, complications, and length of hospital stay	SC
Lee et al, 2016[24]	RCT	South Korea	EUS-BDS	34	66.5	Patients with distal MBOs	Technical and functional success, procedure-related adverse events, reintervention rate, and hospital stay	MC
Khashab et al, 2015[25]	Retrospective case-control study	UnitedStates	EGBD	64	64.9 ± 12.5	Patients with distal MBOs with at least one failed ERCP session	Adverse events, procedure-related costs, and reintervention rates	SC
Artifon et al, 2012[26]	RCT	Brazil	EUS-CD	13	63.4 ± 11.1	Patients with unresectable MBOs	Success rate, quality of life outcomes, and incidence of adverse events	SC
Bill et al, 2016[27]	Retrospective case–control study	United States	EUSr	25	65.4 ± 11.6	Patients with MDBO with a previous failed ERCP	Technical and clinical success, length of hospital stay, and repeat procedure rate	SC

RCT: Randomized controlled trial; EUS-BD: Endoscopic ultrasound-biliary drainage; MC: Multi-center ; SC: Surgical control; EUS-BDS: Endoscopic ultrasound-biliary drainages; EGBD: Endoscopy guided biliary drainage; EUS-CD: Endoscopic ultrasound-guided choledochoduodenostomy; MBOs: Malignant biliary obstructions; MDBO: Malignant distal biliary obstruction; ERCP: Endoscopic retrograde cholangiopancreatography.

Table 3 The Newcastle-Ottawa scale summarizes the methodological quality of the cohort and case-control studies

Ref.	Selection	Comparability	Reporting	AHRQ standard
Khashab et al, 2015[25]	3	1	3	Good
Sharaiha et al, 2016[21]	3	2	3	Good
Bapaye et al, 2013[22]	3	1	3	Good
Huang et al, 2017[23]	3	2	3	Good
Bill et al, 2016[27]	3	1	3	Good

AHRQ: Agency for Healthcare Research and Quality.