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Air Cholangiography versus Contrast Cholangiography in Patients with Hilar Biliary Obstruction: A Systematic Review
Zahid Ijaz Tarar1, Umer Farooq2, Mustafa Gandhi1
1Department of Gastroenterology and Hepatology, School of Medicine, University of Missouri, Columbia, MO, USA.
Background/Aims:
To minimize the risk of post-procedure complications, air cholangiography has been proposed as an alternative to contrast cholangiography in patients with hilar biliary obstruction undergoing endoscopic retrograde cholangiography (ERCP). We compared the rate of post-ERCP complication between these two groups.
Methods:
We systematically reviewed all studies that compared the safety, success, and complication rate of air versus contrast cholangiography in malignant hilar obstruction patients.
Results:
A total of six studies consisting of 450 patients were included in the analysis. The overall rate of post-ERCP complication was less in the air cholangiography group (relative risk [RR]: 0.43, 95% CI: 0.30-0.61, I 2 : 1.97%) compared to the contrast cholangiography group. Compared to contrast cholangiography, the pooled risk of post-ERCP cholangitis was significantly lower in the air cholangiography group (RR: 0.25, 95% CI: 0.14-0.44, I 2 : 0%). There was no difference in risk of post-ERCP pancreatitis (RR: 0.79, 95% CI: 0.32-1.94, I 2 : 0%), bleeding (RR: 1.17, 95% CI: 0.30-4.54), and 30-day mortality (RR: 0.59, 95% CI: 0.23-1.50, I 2 : 0%) between the two groups. The pooled odds of clinical (odds ratio [OR]: 1.14, 95% CI: 0.39-3.34, I 2 : 0%) and technical success (OR: 2.91, 95% CI: 0.52-16.35, I 2 : 0%) were similar between both groups.
Conclusion:
In comparison to contrast cholangiography, air cholangiography had a better safety profile and a lower rate of post-ERCP complications.
