Fugazza Alessandro, Khalaf Kareem, Spadaccini Marco, Facciorusso Antonio, Colombo Matteo, Andreozzi Marta, Carrara Silvia, Binda Cecilia, Fabbri Carlo, Anderloni Andrea, Hassan Cesare, Baron Todd, Repici Alessandro
Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy.
Division of Gastroenterology, St Michael's Hospital, Toronto, Canada.
Endosc Int Open. 2024 Mar 28;12(3):E456-E462. doi: 10.1055/a-2271-2145. eCollection 2024 Mar.
EUS-guided choledochoduodenostomy (EUS-CDS) is a minimally invasive procedure used to treat malignant biliary obstruction (MBO) by transduodenal placement of a lumen-apposing metal stent (LAMS) into the extrahepatic bile duct. To identify factors that contribute to safe and effective EUS-CDS using LAMS, we performed a systematic review of the literature and meta-analysis. The methodology of our analysis was based on PRISMA recommendations. Electronic databases (Medline, Scopus, EMBASE) were searched up to November 2022. Full articles that included patients with distal malignant biliary obstruction who underwent EUS-CDS using LAMS after failed endoscopic retrograde cholangiopancreatography were eligible. Random-effect meta-analysis was performed reporting pooled rates of technical success, clinical success, and adverse events (AEs) by means of a random model. Multivariate meta-regression and subgroup analysis were performed to assess possible associations between the outcomes and selected variables to assess the correlation between outcomes and different variables. Results were also stratified according to stent size. Twelve studies with 845 patients were included in the meta-analysis. Pooled technical and clinical success rates were 96% (95% confidence interval [CI] 94%-98%; I = 52.29%) and 96% (95%CI 95%-98%), respectively, with no significant association with baseline characteristics, such are sex, age, common bile duct diameter, or stent size. The pooled AE rate was 12% (95%CI: 8%-16%; I = 71.62%). The AE rate was significantly lower when using an 8 × 8 mm stent as compared with a 6 × 8 mm LAMS (odds ratio 0.59, 0.35-0.99; = 0.04), with no evidence of heterogeneity (I = 0%). EUS-CDS with LAMS is a safe and effective option for relief of MBO. Selecting an appropriate stent size is crucial for achieving optimal safety outcomes.
超声内镜引导下胆总管十二指肠吻合术（EUS-CDS）是一种微创手术，通过经十二指肠将管腔对合金属支架（LAMS）置入肝外胆管来治疗恶性胆管梗阻（MBO）。为了确定有助于使用LAMS进行安全有效的EUS-CDS的因素，我们对文献进行了系统回顾和荟萃分析。我们的分析方法基于PRISMA建议。检索电子数据库（Medline、Scopus、EMBASE）至2022年11月。纳入的全文需包含在内镜逆行胰胆管造影失败后接受使用LAMS的EUS-CDS治疗的远端恶性胆管梗阻患者。采用随机模型进行随机效应荟萃分析，报告技术成功率、临床成功率和不良事件（AE）的合并率。进行多变量荟萃回归和亚组分析，以评估结局与选定变量之间的可能关联，从而评估结局与不同变量之间的相关性。结果也根据支架尺寸进行分层。荟萃分析纳入了12项研究，共845例患者。技术成功率和临床成功率的合并率分别为96%（95%置信区间[CI]94%-98%；I² = 52.29%）和96%（95%CI 95%-98%），与基线特征（如性别、年龄、胆总管直径或支架尺寸）无显著关联。AE的合并率为12%（95%CI：8%-16%；I² = 71.62%）。与6×8mm的LAMS相比，使用8×8mm支架时AE发生率显著更低（优势比0.59，0.35-0.99；P = 0.04），且无异质性证据（I² = 0%）。使用LAMS的EUS-CDS是缓解MBO的一种安全有效的选择。选择合适的支架尺寸对于实现最佳安全结局至关重要。
