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Effectiveness and safety of EUS-guided choledochoduodenostomy using lumen-apposing metal stents (LAMS): a systematic review and meta-analysis

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Abstract

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.

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Author notes

  1. Rajesh Krishnamoorthi and Chandra S. Dasari shares co-first authorship

Authors and Affiliations

  1. Virginia Mason Medical Center, Digestive Diseases Institute, Seattle, WA, USA

    Rajesh Krishnamoorthi, Joanna Law, Michael Larsen, Richard Kozarek, Andrew Ross & Shayan Irani

  2. Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, USA

    Chandra S. Dasari & Viveksandeep Thoguluva Chandrasekar

  3. University of Kansas Medical Center, Kansas City, KS, USA

    Viveksandeep Thoguluva Chandrasekar

  4. Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Harshith Priyan

  5. University of Nevada, Las Vegas, NV, USA

    Mahendran Jayaraj

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  1. Rajesh Krishnamoorthi
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Corresponding author

Correspondence to Rajesh Krishnamoorthi.

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Disclosures

Rajesh Krishnamoorthi, Chandra S Dasari, Viveksandeep Thoguluva Chandrasekar, Harshith Priyan, Mahendran Jayaraj, Joanna Law, Michael Larson, Shayan Irani they have no conflicts of interest, Richard Kozarek: Research Support- Boston Scientific, Andrew Ross: Consultant – Boston Scientific.

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Krishnamoorthi, R., Dasari, C.S., Thoguluva Chandrasekar, V. et al. Effectiveness and safety of EUS-guided choledochoduodenostomy using lumen-apposing metal stents (LAMS): a systematic review and meta-analysis. Surg Endosc 34, 2866–2877 (2020). https://doi.org/10.1007/s00464-020-07484-w

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