Arnaldo Amato1, Emanuele Sinagra2,3, Ciro Celsa4,5, Marco Enea6, Andrea Buda7, Filippo Vieceli8, Lucia Scaramella1,9, Paul Belletrutti10, Alessandro Fugazza11, Calogero Cammà4, Franco Radaelli1, Alessandro Repici10,11, Andrea Anderloni11. 1. Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy. 2. Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Cefalù, Italy. 3. Euro-Mediterranean Institute of Science and Technology (IEMEST), Section of Nutrition, Palermo, Italy. 4. Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy. 5. Doctoral Programme in Experimental Oncology and Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy. 6. Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy. 7. Gastroenterology Unit, Santa Maria del Prato Hospital, Feltre, Italy. 8. Gastroenterology and Endoscopy Unit, Pancreas Center, University of Verona, Italy. 9. Department of Pathophysiology and Transplantation, University of Milan, Italy. 10. Humanitas University, Department of Biomedical Sciences, Milan, Italy. 11. Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI), Italy.
Abstract
BACKGROUND: Endoscopic ultrasound (EUS)-guided biliary drainage is becoming an option for palliation of malignant biliary obstruction. Lumen-apposing metal stents (LAMS) are replacing self-expandable metal stents (SEMS). The aim of this meta-analysis was to evaluate the efficacy and safety of LAMS and SEMS for EUS-guided choledochoduodenostomy (EUS-CDS). METHODS: A meta-analysis was performed using PRISMA protocols. Electronic databases were searched for studies on EUS-CDS. The primary outcome was clinical success. Secondary outcomes were technical success, reintervention, and adverse events. We used the random effects model with the DerSimonian-Laird estimation, and the results were depicted using forest plots. Subgroup analyses were also performed with data stratified by selected variable. RESULTS: Overall, 31 studies (820 patients) were included. The pooled rates of clinical and technical success were 93.6 % (95 % confidence interval [CI] 88.6 %-96.5 %) and 94.8 % (95 %CI 90.2 %-97.3 %) for LAMS, and 91.7 % (95 %CI 88.1 %-94.2 %) and 92.7 % (95 %CI 89.9 %-94.9 %) for SEMS, respectively. The pooled rates of adverse events were 17.1 % (95 %CI 12.5 %-22.8 %) for LAMS and 18.3 % (95 %CI 14.3 %-23.0 %) for SEMS. The pooled rates of reintervention were 10.9 % (95 %CI 7.7 %-15.3 %) for LAMS and 13.9 % (95 %CI 9.6 %-19.7 %) for SEMS. Subgroup analyses confirmed these results. CONCLUSIONS: This meta-analysis showed that LAMS and SEMS are comparable in terms of efficacy for EUS-CDS. Clinical and technical success, post-procedure adverse events, and reintervention rates were similar between LAMS and SEMS use; however, adverse events require further investigation. Thieme. All rights reserved.
BACKGROUND: Endoscopic ultrasound (EUS)-guided biliary drainage is becoming an option for palliation of malignant biliary obstruction. Lumen-apposing metal stents (LAMS) are replacing self-expandable metal stents (SEMS). The aim of this meta-analysis was to evaluate the efficacy and safety of LAMS and SEMS for EUS-guided choledochoduodenostomy (EUS-CDS). METHODS: A meta-analysis was performed using PRISMA protocols. Electronic databases were searched for studies on EUS-CDS. The primary outcome was clinical success. Secondary outcomes were technical success, reintervention, and adverse events. We used the random effects model with the DerSimonian-Laird estimation, and the results were depicted using forest plots. Subgroup analyses were also performed with data stratified by selected variable. RESULTS: Overall, 31 studies (820 patients) were included. The pooled rates of clinical and technical success were 93.6 % (95 % confidence interval [CI] 88.6 %-96.5 %) and 94.8 % (95 %CI 90.2 %-97.3 %) for LAMS, and 91.7 % (95 %CI 88.1 %-94.2 %) and 92.7 % (95 %CI 89.9 %-94.9 %) for SEMS, respectively. The pooled rates of adverse events were 17.1 % (95 %CI 12.5 %-22.8 %) for LAMS and 18.3 % (95 %CI 14.3 %-23.0 %) for SEMS. The pooled rates of reintervention were 10.9 % (95 %CI 7.7 %-15.3 %) for LAMS and 13.9 % (95 %CI 9.6 %-19.7 %) for SEMS. Subgroup analyses confirmed these results. CONCLUSIONS: This meta-analysis showed that LAMS and SEMS are comparable in terms of efficacy for EUS-CDS. Clinical and technical success, post-procedure adverse events, and reintervention rates were similar between LAMS and SEMS use; however, adverse events require further investigation. Thieme. All rights reserved.
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