Khoury Tawfik, Farraj Moaad, Sbeit Wisam, Fusaroli Pietro, Barbara Giovanni, Binda Cecilia, Fabbri Carlo, Basheer Maamoun, Leblanc Sarah, Fumex Fabien, Gincul Rodica, Teoh Anthony Yuen Bun, Jacques Jérémie, Napoléon Bertrand, Lisotti Andrea
Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel.
AZrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel.
Cancers (Basel). 2025 Jun 13;17(12):1983. doi: 10.3390/cancers17121983.
: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a promising alternative for biliary decompression in patients with malignant distal biliary obstruction (MDBO), used either as a first-line approach or after other interventions have failed. This study aimed to evaluate the aggregated efficacy and safety of EUS-GBD in this patient population. : A comprehensive literature search was carried out across PubMed/Medline, Embase, and Cochrane databases up to 9 January 2024, to identify studies reporting outcomes of EUS-GBD in MDBO cases. The primary endpoint assessed was clinical success, while secondary endpoints included technical success and the incidence of adverse events (AEs). Pooled outcomes were calculated using a random-effects model and presented with 95% confidence intervals (CIs). : Seven studies encompassing a total of 193 patients were included in the analysis. The combined clinical success rate for EUS-GBD was 88.1% [95% CI: 78.9-94.9%], while the technical success rate was 99.2% [95% CI: 97.5-100%]. The overall AE rate was 13.7% [95% CI: 9.3-18.8%], with the majority being mild to moderate in severity; no fatal complications were reported. Subgroup analyses indicated that use of smaller lumen-apposing metal stents (LAMS) (<15 mm) was associated with slightly higher clinical success (93.3% [95% CI: 72.4-99.9%]) compared to larger stents (≥15 mm) (87.1% [95% CI: 78.8-93.5%]), and a marginally lower rate of AEs (12.3% [95% CI: 6.4-19.7%] vs. 15.2% [95% CI: 6.5-26.6%]). : EUS-GBD demonstrates excellent technical performance, high clinical efficacy, and a manageable safety profile in patients with MDBO and a patent cystic duct.
内镜超声引导下胆囊引流术（EUS-GBD）已成为恶性远端胆管梗阻（MDBO）患者胆道减压的一种有前景的替代方法，可作为一线治疗方法或在其他干预措施失败后使用。本研究旨在评估EUS-GBD在该患者群体中的综合疗效和安全性。：截至2024年1月9日，在PubMed/Medline、Embase和Cochrane数据库中进行了全面的文献检索，以确定报告MDBO病例中EUS-GBD结果的研究。评估的主要终点是临床成功，次要终点包括技术成功和不良事件（AE）的发生率。使用随机效应模型计算合并结果，并给出95%置信区间（CI）。：七项研究共纳入193例患者进行分析。EUS-GBD的综合临床成功率为88.1%[95%CI：78.9-94.9%]，技术成功率为99.2%[95%CI：97.5-100%]。总体AE发生率为13.7%[95%CI：9.3-18.8%]，大多数为轻度至中度严重程度；未报告致命并发症。亚组分析表明，与较大支架（≥15mm）（87.1%[95%CI：78.8-93.5%]）相比，使用较小的管腔贴壁金属支架（LAMS）（<15mm）的临床成功率略高（93.3%[95%CI：72.4-99.9%]），AE发生率略低（12.3%[95%CI：6.4-19.7%]对15.2%[95%CI：6.5-26.6%]）。：EUS-GBD在MDBO且胆囊管通畅的患者中显示出优异的技术性能、高临床疗效和可控的安全性。
