Endoscopy · 2026
Lumen-apposing metal stents vs. self-expandable metal stents for endoscopic ultrasound-guided choledochoduodenostomy: a network meta-analysis of randomized controlled trials.
СтатьяNetwork Meta-AnalysisСистематический обзорСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Spadaccini Marco, Chen Yen-I, van Wanrooij Roy L J, Perez-Cuadrado-Robles Enrique, Colombo Matteo, Fugazza Alessandro, Chan Shannon Melissa, Albouys Jérémie, Franchellucci Gianluca, De Marco Alessandro, De Sire Roberto, Ramai Daryl, Fabbri Carlo, Anderloni Andrea, Facciorusso Antonio, Hassan Cesare, Jacques Jeremie, Teoh Anthony Y B, Repici Alessandro
Аннотация
BACKGROUND: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) has emerged as an alternative to endoscopic retrograde cholangiopancreatography (ERCP) for biliary drainage in patients with malignant distal biliary obstruction (MDBO). With cautery-enhanced lumen-apposing metal stents (CE-LAMSs), EUS-CDS has become more feasible, yet concerns remain regarding stent patency and safety. Comparative data between CE-LAMS-based and conventional self-expandable metal stent (SEMS)-based EUS-CDS are lacking. The aim of this analysis was to compare outcomes between the two EUS-CDS strategies using ERCP as a common comparator.
METHODS: A systematic review and network meta-analysis was conducted including randomized controlled trials (RCTs) comparing EUS-CDS using a CE-LAMS or SEMS with ERCP in MDBO. Procedural outcomes were technical success and procedure time; clinical outcomes included clinical success, adverse events (AEs), and cholangitis. Pairwise and network meta-analyses were performed using random-effects models. Ranking probabilities were assessed using the surface under the cumulative ranking curve (SUCRA).
RESULTS: 6 RCTs (707 patients) were included in the analysis. EUS-CDS with CE-LAMS demonstrated significantly higher technical success compared with SEMS-based EUS-CDS (risk ratio [RR] 1.22, 95%CI 1.10 to 1.36) and ERCP (RR 1.18, 95%CI 1.10 to 1.27). It was also associated with shorter procedure time compared with SEMS-based EUS-CDS (standardized mean difference [SMD] -0.78, 95%CI -1.30 to -0.27) and ERCP (SMD -0.84, 95%CI -1.16 to -0.52). No significant differences in clinical success or AEs were found between techniques. According to SUCRA, CE-LAMS ranked highest for technical success and procedural time, while SEMS-based EUS-CDS showed the lowest risk of overall AEs and cholangitis.
CONCLUSION: EUS-CDS with CE-LAMS offers superior procedural efficiency compared with ERCP and SEMS-based approaches with similar clinical success and safety, although concerns about cholangitis warrant further evaluation.
CONCLUSION: PROSPERO registration number: CRD420251126733.
METHODS: A systematic review and network meta-analysis was conducted including randomized controlled trials (RCTs) comparing EUS-CDS using a CE-LAMS or SEMS with ERCP in MDBO. Procedural outcomes were technical success and procedure time; clinical outcomes included clinical success, adverse events (AEs), and cholangitis. Pairwise and network meta-analyses were performed using random-effects models. Ranking probabilities were assessed using the surface under the cumulative ranking curve (SUCRA).
RESULTS: 6 RCTs (707 patients) were included in the analysis. EUS-CDS with CE-LAMS demonstrated significantly higher technical success compared with SEMS-based EUS-CDS (risk ratio [RR] 1.22, 95%CI 1.10 to 1.36) and ERCP (RR 1.18, 95%CI 1.10 to 1.27). It was also associated with shorter procedure time compared with SEMS-based EUS-CDS (standardized mean difference [SMD] -0.78, 95%CI -1.30 to -0.27) and ERCP (SMD -0.84, 95%CI -1.16 to -0.52). No significant differences in clinical success or AEs were found between techniques. According to SUCRA, CE-LAMS ranked highest for technical success and procedural time, while SEMS-based EUS-CDS showed the lowest risk of overall AEs and cholangitis.
CONCLUSION: EUS-CDS with CE-LAMS offers superior procedural efficiency compared with ERCP and SEMS-based approaches with similar clinical success and safety, although concerns about cholangitis warrant further evaluation.
CONCLUSION: PROSPERO registration number: CRD420251126733.