Adverse events in endoscopic ultrasound‐guided choledochoduodenostomy with lumen‐apposing metal stents: A systematic review and meta‐analysis

Abstract

AbstractBackground and AimSeveral meta‐analyses have analyzed the technical and clinical success of endoscopic ultrasound‐guided choledochoduodenostomy (EUS‐CDS) by using lumen‐apposing metal stents (LAMS) in malignant biliary obstruction, but those concerning adverse events (AEs) are scarce. The current systematic review and meta‐analysis was conducted to evaluate the AEs after EUS‐CDS with LAMS.MethodsA comprehensive literature search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was conducted for studies reporting the outcomes of EUS‐CDS with LAMS. The main endpoints were the incidence of overall and specific AEs. Moreover, the stent dysfunction, and reintervention rates were evaluated independently.ResultsA total of 21 studies (n = 1438) were included in the final meta‐analysis. The pooled rate of technical and clinical success was 93.5% (95% confidence interval [CI]: 91.3–95.1) and 88.0% (95% CI: 83.9–91.1), respectively. After EUS‐CDS with LAMS, the pooled incidence of overall AEs was 20.1% (95% CI: 16.0–24.9). The estimated rate of early AEs was 10.6% (95% CI: 7.9–14.2), and late AEs was 11.2% (95% CI: 8.2–15.2). Infection/cholangitis was the commonest AE, with a pooled incidence of 6.1% (95% CI: 3.7–10.1). The estimated incidence of stent dysfunction and reintervention was 10.5% (95% CI: 7.5–14.4), and 12.1% (95% CI: 9.3–15.7), respectively.ConclusionDespite with a high technical and clinical success rate, EUS‐CDS with LAMS may be associated with overall AEs and stent dysfunction in one‐fifth and one‐tenth of cases, respectively. Further efforts are required to optimize its safety and long‐term stent patency.