EFFICACY AND SAFETY OF TRANSMURAL EUS-GUIDED GALLBLADDER DRAINAGE: A META-REGRESSION ANALYSIS

Aims Transmural EUS- guided gallbladder drainage (EUS-GBD) has been increasingly used in the treatment of gallbladder diseases. Aims of the study were to provide a comprehensive meta-analysis and meta-regression of features and outcomes after this procedure.

Methods MEDLINE, Scopus, Web-of-science and Cochrane databases were searched for literature pertinent to trans-mural EUS-GBD up to May 2021. Random-effect meta-analysis of proportions, and meta-regression of potential modifiers of outcome measures considered were applied. Outcome measures were technical success rate, intention-to-treat (ITT) clinical success and procedure-related adverse events (AEs)

Results Twenty-seven articles were identified including 1004 patients enrolled between February 2009 and February 2020.

Acute cholecystitis was present in 98.7% of cases. Pooled technical success was 98.0% (95%C.I.: 96.3, 99.3; heterogeneity: 23.6%), the ITT clinical success was 95.4% (95%C.I.: 92.8, 97.5; heterogeneity: 35.3%) and procedure-related AEs occurred in 14.8% (95%C.I.:8.8, 21.8; heterogeneity: 82.4%), being stent’ malfunction/dislodgment the most frequent (3.5%). Procedural-related mortality was practically nil. Meta-regression showed that center’ experience proxied to≥10 cases/year ameliorated the technical success rate (odds ratio [OR]: 2.84; 95%C.I.:1.06, 7.59; p=0.038) and the ITT clinical success (OR: 3.52; 95%C.I.: 1.33, 9.33; p=0.011). The use of anti-migrating devices also increased the ITT clinical success (OR: 2.16; 95%C.I.: 1.07, 4.36; p=0.031) while reducing procedure-related AEs (OR: 0.36; 95%C.I.: 0.14, 0.98; p=0.045).

Conclusions Physicians’ experience and anti-migrating devices are the main determinant of main clinical outcomes after EUS-GBD, suggesting that treatment in expert centers would optimize results.

Publication History

Article published online:
14 April 2022