Abstract：
OBJECTIVE: Several 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.
METHODS: A 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.
RESULTS: A 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.
CONCLUSIONS: Despite 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.
METHODS: A 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.
RESULTS: A 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.
CONCLUSIONS: Despite 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.
摘要：
目的：一些荟萃分析分析了内镜超声引导胆总管十二指肠造口术（EUS-CDS）在恶性胆道梗阻中使用腔内贴壁金属支架（LAMS）的技术和临床成功，但有关不良事件（AE）的研究很少。目前的系统评价和荟萃分析是为了评估用LAMS进行EUS-CDS后的AE。
方法：对PubMed，Embase,Scopus,WebofScience,和Cochrane图书馆进行的研究报告EUS-CDS与LAMS的结果。主要终点是总体和特异性AE的发生率。此外，支架功能障碍，并独立评估再干预率.
结果：共有21项研究（n=1438）纳入最终的荟萃分析。技术和临床成功率分别为93.5％（95％置信区间[CI]：91.3-95.1）和88.0％（95％CI：83.9-91.1），分别。在使用LAMS的EUS-CDS之后，合并的整体AE发生率为20.1%(95%CI:16.0~24.9).早期AE的估计率为10.6%(95%CI:7.9-14.2)，晚期不良事件发生率为11.2%（95%CI：8.2-15.2）。感染/胆管炎是最常见的AE，合并发生率为6.1%（95%CI：3.7-10.1）。支架功能障碍和再干预的估计发生率为10.5％（95％CI：7.5-14.4），和12.1%（95%CI：9.3-15.7），分别。
结论：尽管技术和临床成功率很高，在五分之一和十分之一的病例中，EUS-CDS与LAMS可能与整体AE和支架功能障碍相关，分别。需要进一步努力以优化其安全性和长期支架通畅性。
方法：对PubMed，Embase,Scopus,WebofScience,和Cochrane图书馆进行的研究报告EUS-CDS与LAMS的结果。主要终点是总体和特异性AE的发生率。此外，支架功能障碍，并独立评估再干预率.
结果：共有21项研究（n=1438）纳入最终的荟萃分析。技术和临床成功率分别为93.5％（95％置信区间[CI]：91.3-95.1）和88.0％（95％CI：83.9-91.1），分别。在使用LAMS的EUS-CDS之后，合并的整体AE发生率为20.1%(95%CI:16.0~24.9).早期AE的估计率为10.6%(95%CI:7.9-14.2)，晚期不良事件发生率为11.2%（95%CI：8.2-15.2）。感染/胆管炎是最常见的AE，合并发生率为6.1%（95%CI：3.7-10.1）。支架功能障碍和再干预的估计发生率为10.5％（95％CI：7.5-14.4），和12.1%（95%CI：9.3-15.7），分别。
结论：尽管技术和临床成功率很高，在五分之一和十分之一的病例中，EUS-CDS与LAMS可能与整体AE和支架功能障碍相关，分别。需要进一步努力以优化其安全性和长期支架通畅性。
