Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2024; 16(3): 907-920
Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.907
Endoscopic-ultrasound-guided biliary drainage with placement of electrocautery-enhanced lumen-apposing metal stent for palliation of malignant biliary obstruction: Updated meta-analysis
Zu-Xiang Peng, Fang-Fang Chen, Wen Tang, Xu Zeng, Hong-Juan Du, Ru-Xian Pi, Hong-Ming Liu, Xiao-Xiao Lu
Zu-Xiang Peng, Wen Tang, Ru-Xian Pi, Hong-Ming Liu, Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
Fang-Fang Chen, Hong-Juan Du, Department of Oncology, Chongqing General Hospital, Chongqing University, Chongqing 401147, China
Xu Zeng, Department of Gastroenterology and Hepatobiliary Surgery, People’s Hospital of Fenggang County, Guizhou 564200, Guizhou Province, China
Xiao-Xiao Lu, Hepatobiliary and Pancreatic Tumor Center, Chongqing University Cancer Hospital, Chongqing 400030, China
Co-first authors: Zu-Xiang Peng and Fang-Fang Chen.
Co-corresponding authors: Hong-Ming Liu and Xiao-Xiao Lu.
Author contributions: Peng ZX, Chen FF, Tang W, Liu HM, and Lu XX contributed to the conceptualization of the study; Peng ZX, Chen FF, Tang W, Zeng X, Du HJ, Pi RX, Liu HM, and Lu XX were involved in the data curation; Peng ZX, Chen FF, Tang W, and Zeng X participated in the formal analysis; Peng ZX, Chen FF, Tang W, Du HJ, and Lu XX contributed in the investigation of the manuscript; Peng ZX was involved in the validation of this article; Peng ZX and Chen FF contributed to the visualization; Peng ZX, Chen FF, Tang W, Liu HM, and Lu XX wrote the original draft; Tang W and Lu XX participated in the methodology; Liu HM and Lu XX contributed to the supervision, project administration, and writing review and editing. Peng ZX and Chen FF contributed equally to this work as co-first authors. The research was performed as a collaborative effort, and the designation of co-first authors authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper's quality and reliability. Peng ZX and Chen FF contributed efforts of equal substance throughout the research process. The choice of these researchers as co-first authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study. Lu XX and Liu HM have made equal contributions to this work as co-corresponding authors. It has been decided to designate Lu XX and Liu HM as co-corresponding authors for two main reasons. First, the co-corresponding authors from the research team possess diverse expertise and skills from different fields, and their designation best reflects this diversity. It also facilitates the most comprehensive and in-depth exploration of the research topic, ultimately enriching readers’ understanding by providing various expert perspectives. Second, Lu XX and Liu HM have made substantial and equal contributions throughout the research process. Selecting these researchers as co-corresponding authors acknowledges and respects their equal contributions, showcasing the collaborative and teamwork spirit within this study. We believe that designating Lu XX and Liu HM as co-corresponding authors is fitting for our manuscript as it accurately reflects the collaborative spirit, equal contributions, and diversity within our team.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Xiao Lu, MD, Hepatobiliary and Pancreatic Tumor Center, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing 400030, China. 377522589@qq.com
Received: October 7, 2023
Peer-review started: October 7, 2023
First decision: December 8, 2023
Revised: January 7, 2024
Accepted: February 18, 2024
Article in press: February 18, 2024
Published online: March 27, 2024
Processing time: 166 Days and 19.2 Hours
ARTICLE HIGHLIGHTS
Research background

Endoscopic-ultrasound-guided biliary drainage (EUS-BD) with electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) has recently been reported as an alternative treatment approach for malignant biliary obstruction after endoscopic retrograde cholangiopancreatography (ERCP) failure.

Research motivation

In 2021, we conducted a meta-analysis focusing on the EUS-guided choledochoduodenostomy with ECE-LAMS for BD. However, only six studies involving 270 patients were included in the analyses. Intriguingly, studies regarding EUS-BD using ECE-LAMS have been widely performed in the last 2 years. Hence, an updated meta-analysis was warranted to determine further the feasibility and safety of ECE-LAMS for palliation of biliary obstruction when ERCP is impossible.

Research objectives

To evaluate the efficacy and safety of EUS-BD with ECE-LAMS for treatment of biliary obstruction after ERCP failure.

Research methods

We searched PubMed, EMBASE and Scopus databases from January 1, 2012 to May 13, 2022. The following search keywords were used: “endoscopic ultrasound”, “EUS”, “lumen-apposing metal stent”, “LAMS”, “electrocautery-enhanced”, “electrocautery-enabled”, “biliary drainage”, “transmural drainage”, “biliary obstruction”, “bile duct obstruction”, and “obstructive jaundice”. The primary outcome of our study was pooled technical success rate. The secondary outcomes were pooled rates of clinical success, reintervention, and adverse events. We ran subgroup analysis comparing studies of different study quality (low vs high), region of origin (Europe vs others), year of publication (before 2021 vs 2021 onwards), cohort size (> 50 vs < 50), and study scale (single center vs multicenter). Funnel plot asymmetry and Egger’s test were used to assess the publication bias. Meta-analysis was performed using a random-effects model following Freeman-Tukey double-arcsine transformation in R software.

Research results

Fourteen studies involving 620 participants were included in the analysis. 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.

Research conclusions

EUS-BD using ECE-LAMS is an effective and safe approach for patients with biliary obstruction when ERCP is impossible. This approach could be generalizable to practitioners in this field.

Research perspectives

The present meta-analysis adopted strict inclusion and exclusion criteria to ensure appropriate methodological quality to evaluate the efficacy and safety of EUS-BD using ECE-LAMS. Large and prospective observational studies are needed to further investigate and confirm our findings.