Background

Endoscopic ultrasound-guided choledochoduodenostomy (CDD) is emerging as an alternative technique for biliary drainage in patients who fail conventional endoscopic retrograde cholangiopancreatography (ERCP). The lumen-apposing metal stents (LAMS) are being increasingly used for CDD. We performed a systematic review and meta-analysis to evaluate the effectiveness and safety of CDD using LAMS.

Methods

We performed a systematic search of multiple databases through May 2019 to identify studies on CDD using covered self-expanding metal stents. Pooled rates of technical success, clinical success, adverse events, and recurrent jaundice associated with CDD using LAMS were estimated. A subgroup analysis was performed based on use of LAMS with electrocautery-enhanced delivery system (EC-LAMS).

Results

Seven studies on CDD using LAMS (with 284 patients) were included in the meta-analysis. Pooled rates of technical and clinical success (per-protocol analysis) were 95.7% (95% CI 93.2–98.1) and 95.9% (95% CI 92.8–98.9), respectively. Pooled rate of post-procedure adverse events was 5.2% (95% CI 2.6–7.9). Pooled rate of recurrent jaundice was 8.7% (95% CI 4.5–12.8).

On subgroup analysis of CDD using EC-LAMS (5 studies with 201 patients), the pooled rates of technical and clinical success (per-protocol analysis) were 93.8% (95% CI 90.4–97.1) and 95.9% (95% CI 91.9–99.9), respectively. Pooled rate of post-procedure adverse events was 5.6% (95% CI 1.7–9.5). Pooled rate of recurrent jaundice was 11.3% (95% CI 6.9–15.7). Heterogeneity (I²) was low to moderate in the analyses.

Conclusion

CDD using LAMS/EC-LAMS is an effective and safe technique for biliary decompression in patients who failed ERCP. Further studies are needed to assess CDD using LAMS as primary treatment modality for biliary obstruction.

中文翻译：

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使用管腔并置金属支架 (LAMS) 进行 EUS 引导胆总管十二指肠吻合术的有效性和安全性：系统评价和荟萃分析。

背景

超声内镜引导胆总管十二指肠吻合术 (CDD) 正在成为传统内镜逆行胰胆管造影术 (ERCP) 失败患者胆道引流的替代技术。管腔并置金属支架 (LAMS) 越来越多地用于 CDD。我们进行了系统回顾和荟萃分析，以评估使用 LAMS 进行 CDD 的有效性和安全性。

方法

截至 2019 年 5 月，我们对多个数据库进行了系统搜索，以确定使用覆盖自膨胀金属支架进行 CDD 的研究。使用 LAMS 估计了与 CDD 相关的技术成功率、临床成功率、不良事件和复发性黄疸的汇总率。基于使用 LAMS 和电灼增强输送系统 (EC-LAMS)，进行了亚组分析。

结果

荟萃分析中包括七项使用 LAMS 的 CDD 研究（284 名患者）。技术和临床成功率（符合方案分析）的合并率分别为 95.7%（95% CI 93.2–98.1）和 95.9%（95% CI 92.8–98.9）。术后不良事件的合并发生率为 5.2% (95% CI 2.6–7.9)。合并黄疸复发率为 8.7% (95% CI 4.5–12.8)。

在使用 EC-LAMS 对 CDD 进行亚组分析时（5 项研究涉及 201 名患者），技术和临床成功率（符合方案分析）的合并率为 93.8%（95% CI 90.4–97.1）和 95.9%（95% CI 91.9） –99.9)，分别。术后不良事件的合并发生率为 5.6%（95% CI 1.7–9.5）。合并黄疸复发率为 11.3% (95% CI 6.9–15.7)。分析中的异质性 ( I ² ) 为低至中等。

结论

使用 LAMS/EC-LAMS 的 CDD 是一种有效且安全的胆道减压技术，用于 ERCP 失败的患者。需要进一步的研究来评估使用 LAMS 作为胆道梗阻主要治疗方式的 CDD。