Comparison of trans-gastric vs trans-enteric(trans-duodenal or trans-jejunal)endoscopic ultrasound guided gallbladder drainage using lumen apposing metal stents  

作　　者：Dheera Grover Ifrah Fatima Murali Dharan 

机构地区：[1]Department of Internal Medicine,University of Connecticut,Farmington,CT 06030,United States [2]Department of Internal Medicine,University of Missouri-Kansas City,Kansas City,MO 64110,United States [3]Department of Gastroenterology and Hepatology,University of Connecticut Health Center,Farmington,CT 06030,United States

出　　处：《World Journal of Gastrointestinal Endoscopy》2023年第9期574-583,共10页世界胃肠内镜杂志（英文版）（电子版）

基　　金：The authors have read the PRISMA 2009 Checklist,and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

摘　　要：BACKGROUND Endoscopic ultrasound guided gallbladder drainage(EUS-GBD)is being increasingly used in practice(either as a bridge to cholecystectomy in high-risk patients or as destination therapy in non-surgical patients).Stents are used to create a conduit between the lumen of the gallbladder(GB)and the intestinal lumen through the gastric or enteric routes.Among the various types of stents used,cautery-enhanced lumen apposing metallic stents(LAMS)may be associated with fewer adverse events(AEs).AIM To compare the clinical success,technical success,and rate of AEs between transgastric(TG)and trans-enteric[transduodenal(TD)/transjejunal(TJ)]approach to GB drainage.Further,we analyzed whether using cautery enhanced stents during EUS-GBD impacts the above parameters.METHODS Study was registered in PROSPERO(CRD42022319019)and comprehensive literature review was conducted.Manuscripts were reviewed for the data collection:Rate of AEs,clinical success,and technical success.Random effects model was utilized for the analysis.RESULTS No statistically significant difference in clinical and technical success between the TD/TJ and TG approaches(P>0.05)were noted.There was no statistically significant difference in the rate of AEs when comparing two-arm studies only.However,when all studies were included in the analysis difference was almost significant favoring the TD/TJ approach.When comparing cautery-enhanced LAMS with non-cautery enhanced LAMS,a statistically significant difference in the rate of AEs was observed when all the studies were included,with the rate being higher in non-cautery enhanced stents(14.0%vs 37.8%;P<0.01).CONCLUSION As per our study results,TD/TJ approach appears to be associated with lower rate of adverse events and comparable efficacy when compared to the TG approach for the EUS-GBD.Additionally,use of cautery-enhanced LAMS for EUS-GBD is associated with a more favorable adverse event profile compared to cold LAMS.Though the approach chosen depends on several patient and physician factors,the above fi

关 键 词：Transduodenal TRANSGASTRIC CAUTERY Endoscopic ultrasound guided gallbladder drainage AXIOS 

分 类 号：R735.9[医药卫生—肿瘤] R575.7[医药卫生—临床医学]