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

Objectives

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.

Methods

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.

Results

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%).

Conclusion

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.