Copyright
©The Author(s) 2024.
World J Gastrointest Surg. Mar 27, 2024; 16(3): 907-920
Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.907
Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.907
Table 1 Characteristics of studies included in the meta-analysis
| Ref. | Country | Setting, center involved (n) | Patient (n) | Age (yr) | Etiology (n) | Reason for failed ERCP (n) | Stent diameter | Follow-up (d) |
| Tsuchiya et al[33], 2018 | Japan, China | Prospective, multicenter (5) | 19 | mean 70.6 (SD, 13.9) | Pancreatic cancer (10), cholangiocarcinoma (2), metastatic renal cancer (2), ampullary cancer (1), metastatic colon cancer (1), sarcoma (1), duodenal cancer (1), metastatic gastric cancer (1) | Duodenal stenosis (4), cannulation failure (15) | 6 mm (10), 8 mm (9) | mean 205.0 (SD, 187.9) |
| Anderloni et al[30], 2019 | Italy | Retrospective, single-center | 46 | mean 73.1 (SD, 12.6) | Pancreatic cancer (40), duodenal cancer (3), ampullary cancer (2), cholangiocarcinoma (1) | Tumoral involvement of the papilla (19), duodenal stenosis (9), cannulation failure (12), ampulla obscured by prior stents (6) | 6 mm (21), 8 mm (19), 10 mm (6) | mean 114.4 (95%CI: 73.2-155.4) |
| El Chafic et al[25], 20191 | United States | Retrospective, multicenter (6) | 67 | mean 68.8 (SD, 11.8) | Peri-ampullary cancer (56), metastatic cancer (11) | Duodenal stenosis (29), tumoral involvement of the papilla (29), cannulation failure (9) | 10 mm (67) | median 119.0 (range, 28-567) |
| Jacques et al[28], 2019 | France | Retrospective, multicenter (10) | 52 | mean 78 (range, 61-92) | Pancreatic cancer (43), cholangiocarcinoma (2), degenerated IPMN (2), duodenal lymphoma (1), peritoneal carcinomatosis (1), stones (1), duodenal cancer (2) | Tumoral involvement of the papilla (10), duodenal stenosis (18), cannulation failure (14), ampulla obscured by prior stents (9), other (1) | 6 mm (43), 8 mm (7), 10 mm (2) | mean 157 |
| Chin et al[26], 20202 | New Zealand | Retrospective, single-center | 60 | median 76 (range, 52-90) | Pancreatic cancer (47), cholangiocarcinoma (3), metastatic cancer (6), duodenal cancer (2), lymphoma (2) | All patients underwent biliary drainage after ERCP failed, but details were not reported | 8 mm (43), 10 mm (17) | mean 237 |
| Jacques et al[31], 2020 | France | Retrospective, multicenter (8) | 70 | mean 75 (range, 61-92) | Pancreatic cancer (54), cholangiocarcinoma (3), ampullary cancer (4), duodenal cancer (2), other (7) | Tumoral involvement of the papilla (15), duodenal stenosis (31), cannulation failure (17), other (7) | 6 mm (60), 8 mm (9), 10 mm (1) | mean 153 |
| Di Mitri et al[35], 2022 | Italy | Retrospective, single-center | 36 | median 75 (IQR, 61-82.5) | Pancreatic cancer (30), duodenal cancer (1), ampullary cancer (2), cholangiocarcinoma (3) | Tumoral involvement of the papilla (9), duodenal stenosis (17), cannulation failure (5), ampulla obscured by prior stents (5) | 6 mm (1), 8 mm (24), 10 mm (9), 15 mm (2) | median 160.0 (IQR, 102-205) |
| Tarantino et al[27], 2021 | Italy | Retrospective, single-center | 21 | NA | Pancreatic cancer (14), duodenal cancer (1), ampullary cancer (3), cholangiocarcinoma (3) | Tumoral involvement of the papilla (12), duodenal stenosis (2), cannulation failure (5), other (2) | 6 mm (1), 8 mm (16), 10 mm (3), 15 mm (1) | mean 188.0 (range, 8-554) |
| Venkatachalapathy et al[34], 2021 | United Kingdom | Prospective, multicenter (3) | 20 | median 76 (range, 65-81) | Pancreatic cancer (12), metastatic cancer (8) | All patients underwent biliary drainage after ERCP failed, but details were not reported | 6 mm (3), 8 mm (17) | NA |
| Garcia-Sumalla et al[36], 20213 | Spain | Retrospective, multicenter (3) | 39 | mean 72.3 (SD, 12.5) | Pancreatic cancer (31), pancreatic neuroendocrine tumor (2), ampullary cancer (3), gastric cardia adenocarcinoma (2), metastatic cancer (1) | Duodenal stenosis (13), cannulation failure (26) | 6 mm (19), 8 mm (20) | mean 81.8 (SD, 82.8) |
| Hindryckx et al[38], 2021 | Belgium | Retrospective, single-center | 13 | NA | NA | NA | NA | NA |
| Yoo et al[29], 2021 | Korea | Retrospective, single-center | 7 | NA | Malignant distal biliary stricture | Tumoral involvement of the papilla (5), ampulla obscured by prior stents (2) | 8 mm (6), 10 mm (1) | NA |
| Ginestet et al[37], 2022 | France | Retrospective, single-center | 50 | mean 76.5 | Pancreatic cancer (43), cholangiocarcinoma (2), ampullary cancer (3), other (2) | Tumoral involvement of the papilla (10), duodenal stenosis (15), cannulation failure (13), other (12) | 6 mm (50) | NA |
| On et al[32], 20224 | United Kingdom, Ireland | Retrospective, multicenter (8) | 120 | median 73.0 (IQR, 17.0) | Pancreatic cancer (77), cholangiocarcinoma (8), ampullary cancer (9), duodenal cancer (14), metastatic cancer (12) | Tumoral involvement of the papilla (32), duodenal stenosis (53), cannulation failure (35) | 6 mm (46), 8 mm (68), 10 mm (5) | median 70.0 (range, 3-869) |
Table 2 Outcomes of included studies in the meta-analysis
| Ref. | Total patient (n) | Technical success | Clinical success | Adverse events | Reintervention (n) | Intra-procedural adverse events (n) | Post-procedural adverse events (n) | Late adverse events (n) |
| Tsuchiya et al[33], 2018 | 19 | 19 | 18 | 7 | 4 | 0 | Cholangitis (2), fever (1) | Stent occlusion (1), stent kinking (1), tumor obstruction (1), stent migration (1) |
| Anderloni et al[30], 2019 | 46 | 43 | 42 | 5 | 4 | 0 | 0 | Bleeding (1), stent occlusion (3), stent migration (1) |
| El Chafic et al[25], 2019 | 67 | 64 | - | - | - | - | - | - |
| Jacques et al[28], 2019 | 52 | 46 | 46 | 9 | 5 | 0 | Cholangitis (1), bleeding (1) | Sump syndrome (2), tumor obstruction (4), stent migration (1) |
| Chin et al[26], 2020 | 60 | 60 | 55 | 12 | 9 | NA | NA | NA |
| Jacques et al[31], 2020 | 70 | 69 | 69 | 9 | 4 | 0 | Bleeding (1), primary dysfunction of stent (1), cholangitis (1) | Tumor obstruction (4), stent migration (1), bacteremia (1) |
| Di Mitri et al[35], 2022 | 36 | 29 | 29 | 9 | 7 | First flange malemployment (2), bleeding (5) | 0 | Tumor obstruction (2) |
| Tarantino et al[27], 2021 | 21 | 21 | 21 | 4 | 1 | 0 | 0 | Stent occlusion (2), tumor obstruction (1), stent migration (1) |
| Venkatachalapathy et al[34], 2021 | 20 | 20 | 19 | 5 | 0 | 0 | Pain (3), cholangitis (1), stent migration (1), | |
| Garcia-Sumalla et al[36], 2021 | 39 | 38 | 32 | 12 | 3 | 0 | Duodenal perforation (1), cholangitis (2), stent migration (1), bleeding (1) | Stent occlusion (7) |
| Hindryckx et al[38], 2021 | 13 | 12 | 11 | 3 | 1 | Duodenal perforation (1) | Cholangitis (1), cholecystitis (1) | - |
| Yoo et al[29], 2021 | 7 | 7 | 7 | 1 | 1 | 0 | Stent occlusion (1) | - |
| Ginestet et al[37], 2022 | 50 | 49 | 45 | 1 | 0 | Bleeding (1) | 0 | 0 |
| On et al[32], 2022 | 120 | 109 | 92 | 21 | 9 | Pneumoperitoneum (2), retroperitoneal air (1), bile leak (2), duodenal perforation (2) | Cholangitis (3), stent occlusion (4) | Cholangitis (2), stent occlusion (3), Stent migration (2) |
Table 3 Subgroup analysis
| Subgroup | No. of studies | No. of patients | Pooled rates as % (95 %CI) | I2 as % | τ2 |
| Technical success rate | |||||
| Low-quality | 5 | 173 | 94.7 (86.7-99.5) | 53.0 | 0.01 |
| High-quality | 9 | 447 | 97.3 (93.8-99.5) | 59.0 | < 0.01 |
| European | 10 | 467 | 95.1 (91.1-98.1) | 55.0 | < 0.01 |
| Outside the European | 4 | 153 | 99.7 (96.1-100.0) | 16.0 | < 0.01 |
| Cohort size (≥ 50 patients) | 6 | 419 | 96.1 (91.8-99.0) | 69.0 | < 0.01 |
| Cohort size (< 50 patients) | 8 | 201 | 96.8 (91.5-99.9) | 45.0 | < 0.01 |
| Single-center | 7 | 233 | 97.0 (90.7-100.0) | 66.0 | 0.01 |
| Multi-center | 7 | 387 | 96.0 (92.3-98.7) | 46.0 | < 0.01 |
| Published before 2021 | 6 | 324 | 97.0 (92.8-99.6) | 60.0 | < 0.01 |
| Published from 2021 onwards | 8 | 306 | 96.1 (90.9-99.4) | 51.0 | < 0.01 |
| Clinical success rate | |||||
| Low-quality | 4 | 106 | 88.4 (80.8-94.6) | 0 | < 0.01 |
| High-quality | 9 | 447 | 91.6 (85.6-96.3) | 75.0 | 0.01 |
| European | 10 | 467 | 89.9 (83.7-94.9) | 73.0 | 0.01 |
| Outside the European | 3 | 86 | 94.6 (87.7-99.1) | 0 | 0 |
| Cohort size (≥ 50 patients) | 5 | 352 | 90.0 (81.4-96.2) | 84.0 | 0.01 |
| Cohort size (< 50 patients) | 8 | 201 | 91.5 (85.1-96.5) | 36.0 | < 0.01 |
| Single-center | 7 | 233 | 91.9 (86.9-95.9) | 29.0 | < 0.01 |
| Multi-center | 6 | 320 | 90.0 (81.2-96.4) | 81.0 | 0.02 |
| Published before 2021 | 5 | 247 | 93.7 (88.6-97.5) | 41.0 | < 0.01 |
| Published from 2021 onwards | 8 | 306 | 88.7 (81.0-94.7) | 60.0 | 0.01 |
| Adverse events rate | |||||
| Low-quality | 4 | 106 | 13.1 (1.6-30.6) | 77.0 | 0.03 |
| High-quality | 9 | 447 | 18.5 (14.4-22.9) | 28.0 | < 0.01 |
| European | 10 | 467 | 16.4 (10.7-22.9) | 60.0 | < 0.01 |
| Outside the European | 3 | 86 | 22.9 (11.9-35.8) | 11.0 | < 0.01 |
| Cohort size (≥ 50 patients) | 5 | 352 | 13.3 (7.1-21.0) | 69.0 | < 0.01 |
| Cohort size (< 50 patients) | 8 | 201 | 22.3 (15.4-30.0) | 13.0 | < 0.01 |
| Single-center | 7 | 233 | 14.1 (6.7-23.3) | 63.0 | 0.01 |
| Multi-center | 6 | 320 | 20.4 (14.2-27.3) | 43.0 | < 0.01 |
| Published before 2021 | 5 | 247 | 16.7 (11.6-22.4) | 39.0 | < 0.01 |
| Published from 2021 onwards | 8 | 306 | 17.8 (9.8-27.3) | 66.0 | 0.01 |
| Reintervention rate | |||||
| Low-quality | 4 | 106 | 6.8 (0-22.6) | 80.0 | 0.03 |
| High-quality | 9 | 447 | 7.9 (5.4-10.8) | 17.0 | < 0.01 |
| European | 10 | 467 | 6.0 (2.8-10.0) | 48.0 | < 0.01 |
| Outside the European | 3 | 86 | 15.1 (7.5-24.2) | 0 | 0 |
| Cohort size (≥ 50 patients) | 5 | 352 | 6.5 (2.1-12.7) | 70.0 | 0.01 |
| Cohort size (< 50 patients) | 8 | 201 | 8.8 (4.0-14.7) | 28.0 | < 0.01 |
| Single-center | 7 | 233 | 7.8 (2.1-15.8) | 67.0 | 0.01 |
| Multi-center | 6 | 320 | 6.9 (4.2-10.2) | 24.0 | < 0.01 |
| Published before 2021 | 5 | 247 | 10.1 (6.1-14.9) | 22.0 | < 0.01 |
| Published from 2021 onwards | 8 | 306 | 5.2 (1.0-11.3) | 59.0 | 0.01 |
- Citation: Peng ZX, Chen FF, Tang W, Zeng X, Du HJ, Pi RX, Liu HM, Lu XX. Endoscopic-ultrasound-guided biliary drainage with placement of electrocautery-enhanced lumen-apposing metal stent for palliation of malignant biliary obstruction: Updated meta-analysis. World J Gastrointest Surg 2024; 16(3): 907-920
- URL: https://www.wjgnet.com/1948-9366/full/v16/i3/907.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v16.i3.907