SUNY Upstate Medical University Syracuse, New York
Introduction: EUS-guided gallbladder drainage (EUS-GBD) is well established as a safe alternative to percutaneous cholecystostomy (PT-GBD) for acute cholecystitis. However, there have been no studies to date comparing the safety and efficacy of the different types of stents for EUS-GBD. Therefore, we conducted a systematic review and meta-analysis to compare the safety and efficacy of lumen-apposing metal stent (LAMS) to Fully covered self-expandable metal stent (FCSEMS) for EUS-GBD.
Methods: A comprehensive literature search was conducted from electronic databases, including PubMed, Embase, and Scopus, from inception until 6/2022. A single-arm meta-analysis was performed using a random-effects approach using restricted maximum likelihood (REML) method comparing proportional data. In addition, subgroup analysis was performed based on the type of stent and comparing the outcomes. All the statistical analysis was conducted using Stata16.
Results: Pooled data from 463 LAMS and 199 FCSEMS across 11 and 6 studies respectively were included in the final analysis (Table 1). There was no significant difference in the technical success rate between FCSEMS vs LAMS (97.61% vs 96.45%, I2 = 8.04%, p= 0.36) However, when compared to LAMS, FCSEMS had a 6% higher clinical success rate (99.2 % versus 93.3%, I2 = 43.87%, p = 0.03) FCSEMS had significantly lower adverse rate of 12.7% when compared to 17.7% LAMS, a difference of 5% (I2 = 54.5%, P = 0.0000). There was no significant difference in recurrent cholecystitis rates between the groups (FCSEMS= 1% vs 1.7%, I2= 3.7%, p =0.41). Although there was a lower mortality seen while using FCSEMS compared to LAMS, it was not statistically significant (I2 = 24.2%, p = 0.17) (Figure 1).
Discussion: Strengths and limitations:
To the best of our knowledge, our study is the first meta-analysis to compare the safety and efficacy of LAMS versus FCSEMS for EUS-GBD.
Patient factors such as comorbidities, health conditions while undergoing the procedure, etc., could not be compared between the groups. There was inadequate data to classify adverse events as severe or mild-moderate. Moderate heterogeneity was noted.
Discussion:
FCSEMS had a higher clinical success rate and fewer adverse events than LAMS for EUS-GBD. There was no difference in technical success, recurrent cholecystitis, or mortality among the two groups. RCTs and observational studies comparing LAMS vs. FCSEMS head-to-head are required to further our understanding in this regard.
