Endoscopic-ultrasound-guided biliary drainage with placement of electrocautery-enhanced lumen-apposing metal stent for palliation of malignant biliary obstruction: Updated meta-analysis

Abstract

BACKGROUND Endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced (ECE) delivery of lumen-apposing metal stent (LAMS) is gradually being recognized as a viable palliative technique for malignant biliary obstruction after endoscopic retrograde cholangiopancreatography (ERCP) failure. However, most of the studies that have assessed its efficacy and safety were small and heterogeneous. Prior meta-analyses of six or fewer studies that were published 2 years ago were therefore underpowered to yield convincing evidence. AIM To update the efficacy and safety of ECE-LAMS for treatment of biliary obstruction after ERCP failure. METHODS We searched PubMed, EMBASE, and Scopus databases from the inception of the ECE technique to May 13, 2022. Primary outcome measure was pooled technical success rate, and secondary outcomes were pooled rates of clinical success, reintervention, and adverse events. Meta-analysis was performed using a random-effects model following Freeman-Tukey double-arcsine transformation in R software (version 4.1.3). RESULTS Fourteen eligible studies involving 620 participants were ultimately included. The pooled rate of technical success was 96.7%, and clinical success was 91.0%. Adverse events were reported in 17.5% of patients. Overall reintervention rate was 7.3%. Subgroup analyses showed results were generally consistent. CONCLUSION ECE-LAMS has favorable success with acceptable adverse events in relieving biliary obstruction when ERCP is impossible. The consistency of results across most subgroups suggested that this is a generalizable approach.

Unveiling the potential of electrocautery-enhanced lumen-apposing metal stents in endoscopic ultrasound-guided biliary drainage

“…In conclusion, Peng et al 's meta-analysis[ 10 ] provides a comprehensive and contemporary overview of the performance of ECE-LAMS in endoscopic biliary-drainage for biliary obstruction due to malignant causes. The very good technical triumph and clinical efficacy, coupled with a relatively acceptable safety profile, are enough to place ECE-LAMS as a promising treatment modality for palliation in challenging clinical aspects.…”

“…The meta-analysis conducted by Peng et al [ 10 ] intends to provide an updated and comprehensive evaluation of the efficacy and safety of biliary drainage through endoscopic-ultrasound guidance by employing ECE-LAMS for the alleviation of malignant biliary obstruction. The systematic review and meta-analysis adhered appropriately to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, ensuring a proper reporting process.…”

“…A former systematic review has carried out a critical appraisal of published papers on EUS-guided interventions[ 9 ]. Nevertheless, the current exploration specifically focuses on the aspect of ECE-LAMS for palliating malignant biliary obstructions[ 10 ]. This is an update and improvement on the systematic review and meta-analysis which was published by the same authors in 2021[ 11 ].…”

Revolutionizing palliative care: Electrocautery-enhanced lumen-apposing metal stents in endoscopic-ultrasound-guided biliary drainage for malignant obstructions

“…We recently had the opportunity to read the current study “Endoscopic-ultrasound-guided biliary drainage (BD) with the placement of an electrocautery-enhanced lumen-apposing metal stent for palliation of malignant biliary obstruction”, recently published in the World Journal of Gastrointestinal Surgery . Peng et al [ 1 ] did a literature search of the published articles on endoscopic-ultrasound-guided BD (EUS-BD) using electrocautery-enhanced (ECE) delivery of lumen-apposing metal stent (LAMS) for malignant biliary obstruction, following the endoscopic retrograde cholangiopancreatography (ERCP) failure.…”

“…Compared to the prior meta-analysis by Peng et al [ 15 ], based on 270 patients/six studies, the current study had a high statistical power since it investigated a large sample of patients ( n = 620) and utilized more stringent inclusion/exclusion parameters in comparison to contemporary studies[ 1 , 15 ]. The principal findings of the current study confirmed the successful management of biliary obstruction through ECE-LAMS in patients who could not qualify for ERCP.…”