Babu P Mohan1, Mohammed Shakhatreh2, Rajat Garg3, Suresh Ponnada4, Udayakumar Navaneethan5, Douglas G Adler6. 1. University of Alabama, DCH Medical Center, Tuscaloosa, AL. 2. Rapides Regional Medical Center, Alexandria, LA. 3. Cleveland Clinic Foundation, Cleveland, OH. 4. Carilion Roanoke Memorial Hospital, Roanoke, VA. 5. Center for Interventional Endoscopy, Florida Hospital, Orlando, FL. 6. Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT.
Abstract
INTRODUCTION: Endoscopic retrograde cholangiopancreatography is the preferred method in biliary drainage. Endoscopic ultrasound (EUS) guidance has shown tremendous success in situations where endoscopic retrograde cholangiopancreatography fails or is contraindicated. EUS-guided choledochoduodenostomy (CDD) in particular is gathering a lot of interest due to its ease, and high rates of success. The reported adverse events with this procedure have been inconsistent among studies. METHODS: We conducted a search of multiple electronic databases and conference proceedings from inception through June 2018. The primary outcome was to estimate the risk of adverse events, and the commonly reported subtype of adverse events in EUS-CDD. The secondary outcome was to estimate the pooled technical and clinical success rates. RESULTS: Thirteen studies including 572 patients underwent biliary drainage with EUS-CDD. The pooled rate of all adverse events was 0.136 (95% confidence interval, 0.097-0.188; P=0.01) with moderate heterogeneity (I=56.9), and pooled rate of cholangitis was 4.2%, bleeding was 4.1%, bile leak was 3.7%, and perforation was 2.9%. On subgroup analysis, the pooled rate of adverse events with the use of lumen-apposing metal stent was 9.3% (95% confidence interval, 4.8-17.3). CONCLUSIONS: On the basis of our analysis EUS-CDD has an adverse event risk of 13.4%, which is lowest reported in literature so far. Reported adverse rates appeared to be lower with the use of lumen-apposing metal stent, except for perforation.
INTRODUCTION: Endoscopic retrograde cholangiopancreatography is the preferred method in biliary drainage. Endoscopic ultrasound (EUS) guidance has shown tremendous success in situations where endoscopic retrograde cholangiopancreatography fails or is contraindicated. EUS-guided choledochoduodenostomy (CDD) in particular is gathering a lot of interest due to its ease, and high rates of success. The reported adverse events with this procedure have been inconsistent among studies. METHODS: We conducted a search of multiple electronic databases and conference proceedings from inception through June 2018. The primary outcome was to estimate the risk of adverse events, and the commonly reported subtype of adverse events in EUS-CDD. The secondary outcome was to estimate the pooled technical and clinical success rates. RESULTS: Thirteen studies including 572 patients underwent biliary drainage with EUS-CDD. The pooled rate of all adverse events was 0.136 (95% confidence interval, 0.097-0.188; P=0.01) with moderate heterogeneity (I=56.9), and pooled rate of cholangitis was 4.2%, bleeding was 4.1%, bile leak was 3.7%, and perforation was 2.9%. On subgroup analysis, the pooled rate of adverse events with the use of lumen-apposing metal stent was 9.3% (95% confidence interval, 4.8-17.3). CONCLUSIONS: On the basis of our analysis EUS-CDD has an adverse event risk of 13.4%, which is lowest reported in literature so far. Reported adverse rates appeared to be lower with the use of lumen-apposing metal stent, except for perforation.
Authors: Albert Garcia-Sumalla; Carme Loras; Vicente Sanchiz; Rafael Pedraza Sanz; Enrique Vazquez-Sequeiros; Jose Ramon Aparicio; Carlos de la Serna-Higuera; Daniel Luna-Rodriguez; Xavier Andujar; María Capilla; Tatiana Barberá; Jose Ramon Foruny-Olcina; Belen Martínez; Miguel Dura; Silvia Salord; Berta Laquente; Cristian Tebe; Sebastia Videla; Manuel Perez-Miranda; Joan B Gornals Journal: Trials Date: 2022-02-25 Impact factor: 2.728
Authors: Giuseppe Vanella; Giuseppe Dell'Anna; Michiel Bronswijk; Roy L J van Wanrooij; Gianenrico Rizzatti; Paraskevas Gkolfakis; Alberto Larghi; Schalk van der Merwe; Paolo Giorgio Arcidiacono Journal: Ann Gastroenterol Date: 2022-07-15
Authors: Kelly E Hathorn; Ahmad Najdat Bazarbashi; Jordan S Sack; Thomas R McCarty; Thomas J Wang; Walter W Chan; Christopher C Thompson; Marvin Ryou Journal: Endosc Int Open Date: 2019-10-22