Abstract
Background. Electrocautery-enhanced lumen-apposing metal stents (ECE-LAMS) have been newly developed to perform EUS-guided choledochoduodenostomy (EUS-CDS), but its benefits and harms remain obscure. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of EUS-CDS using ECE-LAMS. Method. In the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we searched PubMed, Embase, and Scopus databases through January 1, 2001, and April 27, 2020. The primary outcomes of the pooled analysis were to determine the technical success, clinical success, and overall adverse events rates. The secondary outcomes were pooled rates of short-term and long-term adverse events. Results. Six studies with 270 patients were finally included in this meta-analysis. The pooled rates of technical, clinical success, and adverse events were 95.1% (95% CI = 90.6–97.5%, I2 = 25%), 93.3% (95% CI = 87.4–96.5%, I2 = 28%), and 15.3% (95% CI = 10.6–21.6%, I2 = 13%), respectively. The pooled rates of short-term and long-term adverse events were 3.6% (95% CI = 1.3–9.6%, I2 = 0%) and 11.3% (95% CI = 7.6–16.5%, I2 = 0%), respectively. Conclusion. EUS-CDS using ECE-LAMS provides favorable outcomes in patients with biliary obstruction. It has been associated with a higher success rate and a lower rate of adverse events when compared with the biliary drainage approaches previously used. Large and randomized controlled observational studies are required to further refine the findings in the present analysis.
Highlights
Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is prominently applied to perform biliary drainage in patients with biliary obstruction [1]. e failure rate is still about 10%, even though this treatment was performed by expert endoscopists [2,3,4]
In most of the studies, technical success was defined as a successful ECE-LAMS deployment between the bile duct and duodenal lumen, and clinical success was defined as a reduction of at least 50% in total serum bilirubin levels
In 2014, Itoi et al firstly reported one case of successful EUSguided choledochoduodenostomy (EUS-CDS) with LAMS for biliary drainage after endoscopic retrograde cholangiopancreatography (ERCP) failure in a patient with unresectable pancreatic cancer [32]. e EUS-CDS using LAMS or ECE-LAMS has been gradually performed for biliary drainage
Summary
Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is prominently applied to perform biliary drainage in patients with biliary obstruction [1]. e failure rate is still about 10%, even though this treatment was performed by expert endoscopists [2,3,4]. In 2001, Giovannini et al first reported one case of successful EUS-CDS, which places a stent across the duodenal wall into the extrahepatic bile duct, in a patient with malignant biliary obstruction after failed ERCP [7,8,9]. A recent meta-analysis reported that EUS-CDS had a clinical success rate of 88.5% and an adverse event rate of 18.6% [10]. E primary outcomes of the pooled analysis were to determine the technical success, clinical success, and overall adverse events rates. EUS-CDS using ECE-LAMS provides favorable outcomes in patients with biliary obstruction. It has been associated with a higher success rate and a lower rate of adverse events when compared with the biliary drainage approaches previously used. Large and randomized controlled observational studies are required to further refine the findings in the present analysis
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