Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2023; 15(9): 574-583
Published online Sep 16, 2023. doi: 10.4253/wjge.v15.i9.574
Comparison of trans-gastric vs trans-enteric (trans-duodenal or trans-jejunal) endoscopic ultrasound guided gallbladder drainage using lumen apposing metal stents
Dheera Grover, Ifrah Fatima, Murali Dharan
Dheera Grover, Department of Internal Medicine, University of Connecticut, Farmington, CT 06030, United States
Ifrah Fatima, Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64110, United States
Murali Dharan, Department of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT 06030, United States
Author contributions: Grover D and Fatima I contributed to literature search, literature inclusion for the study, and drafting of article; Dharan M contributed to conceptualization of research, literature search, critical revision of article and rewriting the discussions.
Conflict-of-interest statement: All co-authors of this manuscript confirm that there are no financial or personal relationships with any people or organizations that could inappropriately influence the actions of any author of this manuscript.
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:
Corresponding author: Murali Dharan, AGAF, FASGE, MRCP, Assistant Professor, Department of Gastroenterology and Hepatology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, United States.
Received: March 20, 2023
Peer-review started: March 20, 2023
First decision: June 19, 2023
Revised: July 25, 2023
Accepted: August 23, 2023
Article in press: August 23, 2023
Published online: September 16, 2023
Research background

Adequately powered RCTS are need to confirm the findings in our retrospective study.

Research motivation

Transduodenal endoscopic ultrasound guided gallbladder drainage (EUS-GBD) appeard to be safer than transgastric drainage. Hot lumen apposing metallic stents (LAMS) is better than cold LAMS.

Research objectives

As per out study transduodenal approach appeared to have a more favorable adverse event (AE) profile with comparable technical and clinical success when compared to transgastric approach. Cautery enhanced LAMS has a more favorable AE and shorter procedure time than cold LAMS.

Research methods

Literature search was done using PubMed, Embase, Scopus, CENTRAL, CINAHL, and Web of Science database. The inclusion criteria included randomized or nonrandomized controlled clinical trials and prospective and retrospective studies. Due to a lack of data, abstracts presented at conferences and case series (with four or more patients) were also included in the study. Reviews, meta-analyses, animal studies, letters from the editor, case reports, opinion articles, and editorials were not included. The other exclusion criteria included animal studies and studies in languages other than English. No age and gender restrictions were applied. A post-hoc analysis was done to compare the cautery-enhanced (hot) vs non-cautery enhanced approach and only twelve studies met the above-mentioned inclusion criteria. Manuscripts were reviewed for the data collection: Rate of AEs, clinical success, and technical success. The search was conducted again couple of days prior to the submission of this manuscript for the emerging data. Random effects models were estimated using Comprehensive Meta-Analysis (Biostat Inc.) software. A P value of less than 0.05 was considered significant.

Research results

Compare trans-gastric vs trans-enteric EUS-GBD based on available literature. Compare AE profile, technical success and clinical success of both approaches. As a secondary outcome compare cautery enhanced LAMS use vs non-cautery enhanced (cold) LAMS.

Research conclusions

Identify if any transgastric or transenteric EUS-GBD is better based on existing literature.

Research perspectives

EUS-GB being increasingly used either as bridge to cholecystectomy or as destination therapy. GB can be accessed by transgastric or transenteric route. However, it is unclear if one approach is better than the other.