University of Kentucky Lexington, KY, United States
Passisd Laoveeravat, MD1, Wasawat Vutthikraivit, MD2, Thammasak Mingbunjerdsuk, MD1, Gregory S. Bills, MD3, Pradeep Yarra, MD1, Moamen Gabr, MD1, Houssam Mardini, MD1 1University of Kentucky, Lexington, KY; 2University of Iowa, Iowa City, IA; 3University of Kentucky College of Medicine, Lexington, KY
Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) has been widely performed for several indications including choledocholithiasis and malignant biliary obstruction. Endoscopic sphincterotomy is usually performed and can result in endoscopic sphincterotomy related bleeding (ESB). ESB incidence ranges 1-50% according to previous reports. It requires endoscopic intervention such as epinephrine injection, balloon tamponade, thermal cautery, or clips. Fully covered self expandible metal stent (FCSEMS) has become more popular for the ESB treatment. Most of the previous studies on the outcome of FCSEMS include only small numbers of patients. The recommendations in the guideline are based on weak evidences. Therefore, this meta-analysis was conducted to summarize and determine the clinical success rate and complications of FCSEMS as a treatment of ESB.
Methods: We performed the systematic search in MEDLINE and EMBASE through June 2021 for studies on the efficacy and safety of FCSEMS on the treatment of Post ERCP sphincterotomy bleeding. The efficacy is defined by initial hemostatic control and post FCSEMS rebleeding. The safety or complications are post stent placement pancreatitis and stent migration. Data from each study were combined using the random-effects, generic inverse variance method to calculate pooled outcome rate and 95% confidence intervals (CI). I2 statistics was used to assess heterogeneity among studies, with I2>50% indicates significant heterogeneity.
Results: Nine studies consisting of 154 patients were included. The pooled initial hemostatic achievement rate is 99.8% (95%CI: 98.4-101.2) (Figure 1). The risk of rebleeding post stent placement requiring further intervention is 3% (95%CI: -0.3 to 6.4). For the safety of FCSEMS, the pooled rates of pancreatitis and stent migration are 2.7% (95%CI: -0.4 to 5.7) and 3.7% (95%CI: 0.3-7.1), respectively. No heterogeneity is found in all outcome analyses.
Discussion: FCSEMS is considered effective and safe for the treatment of ESB. However, the rebleeding rate in our meta-analysis is solely derived from a single largest study with 97 patients. This means that other studies with smaller numbers of patients do not have enough power to demonstrate the risk of recurrent bleeding post stent placement. Further larger prospective studies are warranted to verify the results particularly the consequences and complications of FCSEMS.
Figure: Figure 1: Forest plot demonstrating the pooled rate of initial hemostatic control of endoscopic sphincterotomy bleeding by FCSEMS
Passisd Laoveeravat indicated no relevant financial relationships.
Wasawat Vutthikraivit indicated no relevant financial relationships.
Thammasak Mingbunjerdsuk indicated no relevant financial relationships.
Gregory Bills indicated no relevant financial relationships.
Pradeep Yarra indicated no relevant financial relationships.
Moamen Gabr indicated no relevant financial relationships.
Houssam Mardini indicated no relevant financial relationships.
Passisd Laoveeravat, MD1, Wasawat Vutthikraivit, MD2, Thammasak Mingbunjerdsuk, MD1, Gregory S. Bills, MD3, Pradeep Yarra, MD1, Moamen Gabr, MD1, Houssam Mardini, MD1. P2732 - The Efficacy and Safety of Fully Covered Self Expandible Metal Biliary Stent for the Treatment of Post ERCP Sphincterotomy Bleeding: A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.