Adverse events with EUS-guided biliary drainage: a systematic review and meta-analysis

Giri, Suprabhat; Mohan, Babu P.; Jearth, Vaneet; Kale, Aditya; Angadi, Sumaswi; Afzalpurkar, Shivaraj; Harindranath, Sidharth

doi:10.1016/j.gie.2023.06.055

Cited by 27 publications

(11 citation statements)

References 158 publications

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“…In our analysis, the pooled incidence of recurrence of biliary obstruction was 16.2% (95%-CI: 11.8-21.8%), after a weight mean time of 165 days (95%-CI: 115-195). Our data are slightly lower to those reported in a recent meta-analysis, in which the rate of reinterventions for EUS-HGS was 20.9% (95%-CI: 16.3-25.6%), being superior to those reported for EUS-CDS (15.8%, 95%-CI: 12.2-19.5%) [42]. A subgroup meta-analysis from Mao et al considering only fully covered-SEMS for EUS-HGS, showed no significant difference in stent obstruction and re-This article is protected by copyright.…”

Section: Accepted Manuscriptcontrasting

confidence: 94%

“…Procedure-related mortality rate was close to zero. Our result is in line with the meta-analysis by Giri et al, that reported a pooled mortality incidence related to EUS-HGS of 0.2% (95%-CI: 0.0-0.5%) and of 0.1% (95%CI: 0.0-0.4%) related to EUS-BD overall [42]. Interestingly, at the meta-regression analysis, center experience (>4 cases/year) was found to be an independent modifier of both technical and clinical success.…”

Section: Accepted Manuscriptsupporting

confidence: 93%

“…In a meta-analysis by Uemura and colleagues higher rates of cholangitis have been shown for EUS-CDS rather than EUS-HGS (31% versus 10% of AEs, respectively) [46]. However, other studies did not confirm the same results [42]. In our analysis, the rate of cholangitis was relatively low 2.8% (95% CI; 1.5-5.2%), comparable to previous studies and to those reported with ERCP [45].…”

Section: Accepted Manuscriptsupporting

confidence: 72%

“…Although high, clinical success was suboptimal, being 88.1% (95%-CI: 84.7-91.2%, I 2 =33.9%) and 91% (95%-CI: 88.2-93.3%, I 2 =16%) in the ITT and in per-procedure analysis respectively. When compared to other EUS-BD modalities, no significant differences in clinical success has been reported [42].…”

Section: Discussionmentioning

confidence: 94%

“…In our study the overall rate of procedure-related AEs was 12% (95%-CI: 9.8-14.5%, I 2 =20.4%), mainly represented by cholangitis or sepsis, bleeding, biliary leak and pneumoperitoneum. Although not negligible, the overall rate of AEs is lower when compared to PTBD [3], while is commensurate when compared to other EUS-BD [42]. Indeed, despite high technical and clinical success rates, previous studies and meta-analyses have reported that PTBD is associated with a higher rate of AEs and need for re-intervention than EUS-BD, mainly due to an increased risk of stent dysfunction and stent dislodgement [3].…”

Section: Accepted Manuscriptmentioning

confidence: 93%

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Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy: a meta-regression analysis

Binda,

Dajti,

Giuffrida

et al. 2024

Endoscopy

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Background and study aim: EUS-guided hepaticogastrostomy (EUS-HGS) is a valid option for EUS-guided biliary drainage that has been increasingly used in the last decade. The aims of the study were to provide a systematic review with meta-analysis and meta-regression of features and outcomes of this procedure. Methods: MEDLINE, Scopus, Web-of-Science, and Cochrane databases were searched for literature pertinent to EUS-HGS. Meta-analysis of proportions and meta-regression of potential modifiers of the main outcome measures were applied. The main outcome was technical success. Secondary outcomes were clinical success and procedure-related adverse events (AEs). Results: Thirty-three studies including 1644 patients were included in the meta-analysis. Malignant biliary obstruction was the underlying cause in almost all (99.6%) cases; the main indications for EUS-HGS were duodenal/papillary invasion (34.8%), surgical altered anatomy (18.4%) and hilar stenosis (16%). Pooled technical success of EUS-HGS was 97.7% (95%-CI: 96.1-99%, I2=0%), the intention to treat (ITT) clinical success was 88.1% (95%-CI: 84.7-91.2%, I2=33.9%) and procedure-related AEs occurred in 12% (95%-CI: 9.8-14.5%, I2=20.4%), being cholangitis/sepsis (2.8%) and bleeding (2.3%) the most frequent. The rate of procedure related AEs was reduced with the use of dedicated stents at the univariable meta regression analysis. Meta-regression showed that technical success and clinical success rates were modified by centers’ experience (>4/year). Conclusions: EUS-HGS represents an effective and safe procedure for EUS-guided biliary drainage in patients with malignant biliary obstruction. Future studies should address the impact of center experience, patient selection, and use of dedicated stents to improve this technique’s performance.

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Section: Accepted Manuscriptcontrasting

confidence: 94%

Section: Accepted Manuscriptsupporting

confidence: 93%

Section: Accepted Manuscriptsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 94%

Section: Accepted Manuscriptmentioning

confidence: 93%

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Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy: a meta-regression analysis

Binda,

Dajti,

Giuffrida

et al. 2024

Endoscopy

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Radial force and wire structure determine the onset of covered self‐expandable metal stent migration in endoscopic ultrasound‐guided hepaticogastrostomy: Measurement of sliding‐resistance force using a porcine model

Koga,

Yamada,

Ishida

et al. 2024

J Hepato Biliary Pancreat

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BackgroundSelf‐expandable metal stent (SEMS) migration after endoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS) is a severe complication. The migration risk could be related to the surface friction of SEMS, assumed to be affected by the wire structure and mechanical properties, including radial force (RF); however, their relevance remains unclear. This experimental study aimed to assess the mechanical properties of SEMS involved in the onset of stent migration by measuring the sliding‐resistance force (SF) as the SEMS moves through the stomach wall.MethodsThe SF of seven types of 8‐mm diameter SEMS (four braided and three laser‐cut types) and porcine stomach wall was measured with a universal testing machine. The SF of each SEMS was measured three times, and the average maximum SF (SFmax) was used for analysis. The correlation between SFmax and RF of each SEMS was evaluated.ResultsSFmax and RF showed a very strong positive correlation (r = 0.92). Compared to the regression line predictions in the scatter plots of SFmax and RF, the SFmax of laser‐cut and braided type SEMSs had positive and negative residuals, respectively.ConclusionsSelecting a laser‐cut type SEMS with a higher RF may more effectively prevent the onset of stent migration against the stomach wall in EUS‐HGS.

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Adverse events with endoscopic ultrasound‐guided gastroenterostomy for gastric outlet obstruction—A systematic review and meta‐analysis

Giri,

Harindranath,

Mohan

et al. 2024

UEG Journal

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BackgroundThe technical and clinical effectiveness of endoscopic ultrasonography (EUS)‐guided gastroenterostomy (GE) has been reported by several meta‐analyses, but few of them have addressed the adverse events (AE). The goal of the current meta‐analysis was to analyze the AEs associated with various types of EUS‐GE.MethodsAll relevant studies reporting the AEs with EUS‐GE were searched from 2000 to 31st March 2023 in MEDLINE, Embase, and Scopus. The event rates were pooled using a random effects model.ResultsA total of 36 studies (n = 1846) were included in the meta‐analysis. The present meta‐analysis reports a pooled technical success rate of 96.9% (95.9–98.0; I2 = 29.3%) with a pooled clinical success rate of 90.6% (88.5–92.7; I2 = 60.9%). The pooled incidence of overall AEs with EUS‐GE was 13.0% (10.3–15.7; I2 = 69.7%), with the commonest being maldeployment of the stent, seen in 4.6% (3.2–6.0; I2 = 50.6%). The pooled incidences of serious AE and procedure‐related mortality were 1.2% (0.7–1.8; I2 = 1.9%) and 0.3% (0.0–0.7; I2 = 0.0%), respectively. Subgroup analysis of studies using only the free‐hand technique showed a significantly lower overall AE and maldeployment but not serious AE and other individual AEs. The pooled incidences of delayed stent migration and stent occlusion were 0.5% (0.0–1.1; I2 = 0.0%) and 0.8% (0.2–1.3; I2 = 0.0%), respectively.ConclusionDespite a technical and clinical success rate of >90%, AEs are seen in around one‐seventh of the cases of EUS‐GE, maldeployment being the commonest. However, the pooled incidence of serious AE and mortality remains low, which is reassuring.

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Adverse events with EUS-guided biliary drainage: a systematic review and meta-analysis

Cited by 27 publications

References 158 publications

Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy: a meta-regression analysis

Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy: a meta-regression analysis

Radial force and wire structure determine the onset of covered self‐expandable metal stent migration in endoscopic ultrasound‐guided hepaticogastrostomy: Measurement of sliding‐resistance force using a porcine model

Adverse events with endoscopic ultrasound‐guided gastroenterostomy for gastric outlet obstruction—A systematic review and meta‐analysis

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