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Surgical Endoscopy
Published in: Surgical Endoscopy 7/2020

01-07-2020 | Endoscopic Retrograde Cholangiopancreatography | Review Article

Effectiveness and safety of EUS-guided choledochoduodenostomy using lumen-apposing metal stents (LAMS): a systematic review and meta-analysis

Authors: Rajesh Krishnamoorthi, Chandra S. Dasari, Viveksandeep Thoguluva Chandrasekar, Harshith Priyan, Mahendran Jayaraj, Joanna Law, Michael Larsen, Richard Kozarek, Andrew Ross, Shayan Irani

Published in: Surgical Endoscopy | Issue 7/2020

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Abstract

Background

Endoscopic ultrasound-guided choledochoduodenostomy (CDD) is emerging as an alternative technique for biliary drainage in patients who fail conventional endoscopic retrograde cholangiopancreatography (ERCP). The lumen-apposing metal stents (LAMS) are being increasingly used for CDD. We performed a systematic review and meta-analysis to evaluate the effectiveness and safety of CDD using LAMS.

Methods

We performed a systematic search of multiple databases through May 2019 to identify studies on CDD using covered self-expanding metal stents. Pooled rates of technical success, clinical success, adverse events, and recurrent jaundice associated with CDD using LAMS were estimated. A subgroup analysis was performed based on use of LAMS with electrocautery-enhanced delivery system (EC-LAMS).

Results

Seven studies on CDD using LAMS (with 284 patients) were included in the meta-analysis. Pooled rates of technical and clinical success (per-protocol analysis) were 95.7% (95% CI 93.2–98.1) and 95.9% (95% CI 92.8–98.9), respectively. Pooled rate of post-procedure adverse events was 5.2% (95% CI 2.6–7.9). Pooled rate of recurrent jaundice was 8.7% (95% CI 4.5–12.8).
On subgroup analysis of CDD using EC-LAMS (5 studies with 201 patients), the pooled rates of technical and clinical success (per-protocol analysis) were 93.8% (95% CI 90.4–97.1) and 95.9% (95% CI 91.9–99.9), respectively. Pooled rate of post-procedure adverse events was 5.6% (95% CI 1.7–9.5). Pooled rate of recurrent jaundice was 11.3% (95% CI 6.9–15.7). Heterogeneity (I2) was low to moderate in the analyses.

Conclusion

CDD using LAMS/EC-LAMS is an effective and safe technique for biliary decompression in patients who failed ERCP. Further studies are needed to assess CDD using LAMS as primary treatment modality for biliary obstruction.
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Literature
1.
Meseeha M, Attia M (2019) Endoscopic Retrograde Cholangiopancreatography (ERCP). StatPearls Treasure Island (FL)
2.
Krishnamoorthi R, Jayaraj M, Kozarek R (2017) Endoscopic stents for the biliary tree and pancreas. Curr Treat Options Gastroenterol 15(3):397–415CrossRef
3.
Garcarek J, Kurcz J, Guzinski M, Janczak D, Sasiadek M (2012) Ten years single center experience in percutaneous transhepatic decompression of biliary tree in patients with malignant obstructive jaundice. Adv Clin Exp Med 21(5):621–632PubMed
4.
Krishnamoorthi R, Ross A (2019) Endoscopic management of biliary disorders: diagnosis and therapy. Surg Clin North America 99(2):369–386CrossRef
5.
Itoi T, Dhir V (2016) EUS-guided biliary rendezvous: slow, hesitant, baby steps forward. Gastrointest Endosc 83(2):401–403CrossRef
6.
Itoi T, Dhir V, Moon JH (2017) EUS-guided biliary drainage: moving into a new era of biliary drainage. Gastrointest Endosc 85(5):915–917CrossRef
7.
Khashab MA, Van der Merwe S, Kunda R, El Zein MH, Teoh AY, Marson FP et al (2016) Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography. Endosc Int Open 4(4):E487–E496CrossRef
8.
Hedjoudje A, Sportes A, Grabar S, Zhang A, Koch S, Vuitton L et al (2019) Outcomes of endoscopic ultrasound-guided biliary drainage: A systematic review and meta-analysis. United Eur Gastroenterol J 7(1):60–68CrossRef
9.
Kunda R, Perez-Miranda M, Will U, Ullrich S, Brenke D, Dollhopf M et al (2016) EUS-guided choledochoduodenostomy for malignant distal biliary obstruction using a lumen-apposing fully covered metal stent after failed ERCP. Surg Endosc 30(11):5002–5008CrossRef
10.
Mussetto A, Fugazza A, Fuccio L, Triossi O, Repici A, Anderloni A (2018) Current uses and outcomes of lumen-apposing metal stents. Ann Gastroenterol 31(5):535–540PubMedPubMedCentral
11.
Artifon EL, Takada J, Okawa L, Moura EG, Sakai P (2010) EUS-guided choledochoduodenostomy for biliary drainage in unresectable pancreatic cancer: a case series. Jop 11(6):597–600PubMed
12.
Anderloni A, Fugazza A, Troncone E, Auriemma F, Carrara S, Semeraro R et al (2019) Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction. Gastrointest Endosc 89(1):69–76CrossRef
13.
Itonaga M, Kitano M, Hatamaru K, Tamura T, Nuta J, Kawaji Y et al (2018) Endoscopic ultrasound-guided choledochoduodenostomy using a thin stent delivery system in patients with unresectable malignant distal biliary obstruction: a prospective multicenter study. Dig Endo 31(3):291–298. https://​doi.​org/​10.​1111/​den.​13300 CrossRef
14.
Rai P, Lokesh CR, Goel A, Aggarwal R (2018) Endoscopic ultrasound-guided choledochoduodenostomy using partially-covered self-expandable metal stent in patients with malignant distal biliary obstruction and unsuccessful ERCP. Endosc Int Open 6(1):E67–E72CrossRef
15.
Vila JJ, Perez-Miranda M, Vazquez-Sequeiros E, Abadia MA, Perez-Millan A, Gonzalez-Huix F et al (2012) Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey. Gastrointest Endosc 76(6):1133–1141CrossRef
16.
Jacques J, Privat J, Pinard F, Fumex F, Valats JC, Chaoui A et al (2019) Endoscopic ultrasound-guided choledochoduodenostomy with electrocautery-enhanced lumen-apposing stents: a retrospective analysis. Endoscopy 51(6):540–547CrossRef
17.
EI Chafic AH, Shah JN, Hamerski C, Binmoeller KF, Irani S, James TW et al (2019) EUS-guided choledochoduodenostomy for distal malignant biliary obstruction using electrocautery-enhanced lumen-apposing metal stents: first US Multicenter Experience. Dig Dis Sci 64(11):3321–3327. https://​doi.​org/​10.​1007/​s10620-019-05688-2 CrossRef
18.
Tsuchiya T, Teoh AYB, Itoi T, Yamao K, Hara K, Nakai Y et al (2018) Long-term outcomes of EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction: a prospective multicenter study. Gastrointest Endosc 87(4):1138–1146CrossRef
19.
20.
Teoh AYB, Kongkam P, Bapaye A, Ratanchu-ek T, Chan SM, Lee YN, Reknimitr R, Ridtitid W, Moon JH (2019) Prospective multicenter international study on the use of A newly developed self approximating lumen apposing metallic stent for drainage of the bile duct and gallbladder. Dig Dis Week. https://​doi.​org/​10.​1111/​den.​13494 CrossRef
21.
Higgins J GS. cochrane handbook of systematic reviews of interventions version 5.1.0. 2011.
22.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Internal Med. 151(4):264–269CrossRef
23.
Stang A (2010) Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605CrossRef
24.
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188CrossRef
25.
Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M et al (2011) GRADE guidelines: 7. Rating the quality of evidence–inconsistency. J Clin Epidemiol 64(12):1294–1302CrossRef
26.
Easterbrook PJ, Gopalan R, Berlin JA, Matthews DR (1991) Publication bias in clinical research. Lancet 337(8746):867–872CrossRef
27.
Itonaga M, Kitano M, Hatamaru K, Tamura T, Nuta J, Kawaji Y et al (2019) Endoscopic ultrasound-guided choledochoduodenostomy using a thin stent delivery system in patients with unresectable malignant distal biliary obstruction: a prospective multicenter study. Digest Endosc 31(3):291–298CrossRef
28.
Paik WH, Lee TH, Park DH, Choi JH, Kim SO, Jang S et al (2018) EUS-guided biliary drainage versus ERCP for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial. Am J Gastroenterol 113(7):987–997CrossRef
29.
Bang JY, Navaneethan U, Hasan M, Hawes R, Varadarajulu S (2018) Stent placement by EUS or ERCP for primary biliary decompression in pancreatic cancer: a randomized trial (with videos). Gastrointest Endosc 88(1):9–17CrossRef
30.
Cho DH, Lee SS, Oh D, Song TJ, Park DH, Seo DW et al (2017) Long-term outcomes of a newly developed hybrid metal stent for EUS-guided biliary drainage (with videos). Gastrointest Endosc 85(5):1067–1075CrossRef
31.
Artifon EL, Marson FP, Gaidhane M, Kahaleh M, Otoch JP (2015) Hepaticogastrostomy or choledochoduodenostomy for distal malignant biliary obstruction after failed ERCP: is there any difference? Gastrointest Endosc 81(4):950–959CrossRef
32.
Chan SM, Teoh AY (2015) Endoscopic ultrasound-guided biliary drainage: a review. Curr Treat Options Gastroenterol 13(2):171–184CrossRef
33.
Park JK, Woo YS, Noh DH, Yang JI, Bae SY, Yun HS et al (2018) Efficacy of EUS-guided and ERCP-guided biliary drainage for malignant biliary obstruction: prospective randomized controlled study. Gastrointest Endosc 88(2):277–282CrossRef
34.
Attasaranya S, Netinasunton N, Jongboonyanuparp T, Sottisuporn J, Witeerungrot T, Pirathvisuth T et al (2012) The spectrum of endoscopic ultrasound intervention in biliary diseases: a single center's experience in 31 cases. Gastroenterol Res Pract 2012:680753CrossRef
35.
Jain D, Shah M, Patel U, Sharma A, Singhal S (2018) Endoscopic. Digestion 98(1):1–10CrossRef
36.
Wang K, Zhu J, Xing L, Wang Y, Jin Z, Li Z (2016) Assessment of efficacy and safety of EUS-guided biliary drainage: a systematic review. Gastrointest Endosc 83(6):1218–1227CrossRef
37.
Kalva NR, Vanar V, Forcione D, Bechtold ML, Puli SR (2018) Efficacy and Safety of lumen apposing self-expandable metal stents for EUS guided cholecystostomy: a meta-analysis and systematic review. Can J Gastroenterol Hepatol 2018:7070961CrossRef
38.
Garcia-Alonso FJ, Sanchez-Ocana R, Penas-Herrero I, Law R, Sevilla-Ribota S, Torres-Yuste R et al (2018) Cumulative risks of stent migration and gastrointestinal bleeding in patients with lumen-apposing metal stents. Endoscopy 50(4):386–395CrossRef
39.
Brimhall B, Han S, Tatman PD, Clark TJ, Wani S, Brauer B et al (2018) Increased Incidence of Pseudoaneurysm bleeding with lumen-apposing metal stents compared to double-pigtail plastic stents in patients with peripancreatic fluid collections. Clin Gastroenterol Hepatol 16(9):1521–1528CrossRef
Metadata
Title
Effectiveness and safety of EUS-guided choledochoduodenostomy using lumen-apposing metal stents (LAMS): a systematic review and meta-analysis
Authors
Rajesh Krishnamoorthi
Chandra S. Dasari
Viveksandeep Thoguluva Chandrasekar
Harshith Priyan
Mahendran Jayaraj
Joanna Law
Michael Larsen
Richard Kozarek
Andrew Ross
Shayan Irani
Publication date
01-07-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 7/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07484-w

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