内镜逆行胰胆管造影失败后，使用电灼增强管腔贴附金属支架进行内镜超声引导下胆总管十二指肠吻合术用于胆道引流的有效性和安全性的荟萃分析。

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.

作者信息

Ibnawadh Safiya, Alfadda Abdulrahman, Ibnawadh Abdulrahman

机构信息

Department of Medicine Section of Gastroenterology King Faisal Specialist Hospital and Research Center Riyadh Saudi Arabia.

Department of Medicine King Faisal Specialist Hospital and Research Center Riyadh Saudi Arabia.

出版信息

DEN Open. 2025 Apr 23;5(1):e70105. doi: 10.1002/deo2.70105. eCollection 2025 Apr.

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.

目的

内镜超声引导下胆道引流术和胆总管十二指肠吻合术（EUS-CDD）越来越多地被用作内镜逆行胰胆管造影术失败患者的胆道引流替代手术。新型电灼增强管腔贴附金属支架（EC-LAMS）有望广泛应用于EUS-CDD。我们进行了一项系统评价和荟萃分析，以评估使用EC-LAMS进行EUS-CDD的技术和临床成功率。

方法

我们对多个数据库进行了全面检索，检索时间从数据库建立至2022年5月，以查找有关使用EC-LAMS进行内镜超声引导下胆道引流有效性和安全性的相关研究。计算技术成功率、临床成功率以及早期和晚期不良事件的合并发生率。

结果

本分析纳入了10项研究，共481例患者。总体技术成功率为94.3%，95%置信区间[CI]（91.5%-96.2%），总体临床成功率为94.9%，95%CI（92%-96.7%）。总体早期不良事件发生率为5.1%，95%CI（3.4%-7.8%），总体晚期不良事件发生率为10.8%，95%CI（6.6%-17.2%）。