Endoscopy 2021; 53(10): 1037-1047
DOI: 10.1055/a-1324-7919
Systematic review

Efficacy of lumen-apposing metal stents or self-expandable metal stents for endoscopic ultrasound-guided choledochoduodenostomy: a systematic review and meta-analysis

 1  Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
,
Emanuele Sinagra
 2  Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Cefalù, Italy
 3  Euro-Mediterranean Institute of Science and Technology (IEMEST), Section of Nutrition, Palermo, Italy
,
Ciro Celsa
 4  Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
 5  Doctoral Programme in Experimental Oncology and Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy
,
Marco Enea
 6  Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
,
Andrea Buda
 7  Gastroenterology Unit, Santa Maria del Prato Hospital, Feltre, Italy
,
Filippo Vieceli
 8  Gastroenterology and Endoscopy Unit, Pancreas Center, University of Verona, Italy
,
Lucia Scaramella
 1  Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
 9  Department of Pathophysiology and Transplantation, University of Milan, Italy
,
Paul Belletrutti
10  Humanitas University, Department of Biomedical Sciences, Milan, Italy
,
11  Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI), Italy
,
Calogero Cammà
 4  Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
,
Franco Radaelli
 1  Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
,
Alessandro Repici
10  Humanitas University, Department of Biomedical Sciences, Milan, Italy
11  Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI), Italy
,
Andrea Anderloni
11  Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI), Italy
› Author Affiliations

Abstract

Background Endoscopic ultrasound (EUS)-guided biliary drainage is becoming an option for palliation of malignant biliary obstruction. Lumen-apposing metal stents (LAMS) are replacing self-expandable metal stents (SEMS). The aim of this meta-analysis was to evaluate the efficacy and safety of LAMS and SEMS for EUS-guided choledochoduodenostomy (EUS-CDS).

Methods A meta-analysis was performed using PRISMA protocols. Electronic databases were searched for studies on EUS-CDS. The primary outcome was clinical success. Secondary outcomes were technical success, reintervention, and adverse events. We used the random effects model with the DerSimonian–Laird estimation, and the results were depicted using forest plots. Subgroup analyses were also performed with data stratified by selected variable.

Results Overall, 31 studies (820 patients) were included. The pooled rates of clinical and technical success were 93.6 % (95 % confidence interval [CI] 88.6 %–96.5 %) and 94.8 % (95 %CI 90.2 %–97.3 %) for LAMS, and 91.7 % (95 %CI 88.1 %–94.2 %) and 92.7 % (95 %CI 89.9 %–94.9 %) for SEMS, respectively. The pooled rates of adverse events were 17.1 % (95 %CI 12.5 %–22.8 %) for LAMS and 18.3 % (95 %CI 14.3 %–23.0 %) for SEMS. The pooled rates of reintervention were 10.9 % (95 %CI 7.7 %–15.3 %) for LAMS and 13.9 % (95 %CI 9.6 %–19.7 %) for SEMS. Subgroup analyses confirmed these results.

Conclusions This meta-analysis showed that LAMS and SEMS are comparable in terms of efficacy for EUS-CDS. Clinical and technical success, post-procedure adverse events, and reintervention rates were similar between LAMS and SEMS use; however, adverse events require further investigation.

Tables 1s–8s, Figs. 1s–6s



Publication History

Received: 23 September 2019

Accepted after revision: 27 November 2020

Publication Date:
27 November 2020 (online)

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