A meta‐analysis of the effectiveness and safety of endoscopic ultrasound‐guided choledochoduodenostomy employing electrocautery‐enhanced lumen‐apposing metal stents for biliary drainage after failed endoscopic retrograde cholangiopancreatography

TL;DR

This study evaluates the effectiveness and safety of a new endoscopic procedure using metal stents for biliary drainage when traditional methods fail.

Contribution

The study provides a meta-analysis of electrocautery-enhanced lumen-apposing metal stents for endoscopic ultrasound-guided choledochoduodenostomy.

Findings

The overall technical success rate of the procedure was 94.3%.

The overall clinical success rate was 94.9%.

Adverse events occurred in 5.1% early and 10.8% late cases.

Abstract

Endoscopic ultrasound‐biliary drainage and choledochoduodenostomy (EUS‐CDD) are increasingly being used as alternative procedures for biliary drainage in patients in whom endoscopic retrograde cholangiopancreatography fails. Novel electrocautery‐enhanced lumen‐apposing metal stents (EC‐LAMS) are expected to be widely used for EUS‐CDD. We performed a systematic review and meta‐analysis to evaluate the technical and clinical success of EUS‐CDD using EC‐LAMS.

We performed a comprehensive search of several databases from inception to May 2022 to search for relevant studies on the effectiveness and safety of endoscopic ultrasound‐guided biliary drainage using EC‐LAMS. The pooled rates of technical success, clinical success, and early and late adverse events were calculated.

Ten studies with a total of 481 patients were included in this analysis. The overall technical success rate was 94.3%, 95% confidence interval [CI] (91.5%–96.2%), The overall clinical success rate was 94.9%, 95% CI (92%–96.7%). The overall early adverse event rate was 5.1%, 95% CI (3.4%–7.8%), and the overall late adverse event rate was 10.8%, 95% CI (6.6%–17.2%).

In patients with biliary obstruction with failed endoscopic retrograde cholangiopancreatography, EUS‐CDD using EC‐LAMS is a good alternate management option with a high success rate and relatively low adverse events.

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