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ORIGINAL ARTICLE
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Adverse events with lumen-apposing metal stents in endoscopic gallbladder drainage: A systematic review and meta-analysis


1 Inpatient Medicine, Banner University Medical Center/ University of Arizona, Tucson, Arizona, USA
2 Division of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
3 Department of Hospital Medicine, Rapides Regional Medical Center, Alexandria, Louisiana, USA
4 Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
5 Department of Hospital Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, USA
6 Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA
7 Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA

Correspondence Address:
Douglas G Adler,
Division of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, Salt Lake City, Utah 84132
USA
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_63_18

Background: Lumen-apposing metal stents (LAMS) are rapidly being used in endoscopic interventional drainage procedures and have started to replace the self-expanding metal stents (SEMSs). Its use in gallbladder drainage (GBD) is limited by lack of good-quality studies, and data are scarce on its safety. Methods: We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, Embase, and Web of Science databases (from inception through July 2018) to identify studies that reported on the use of LAMS in GBD. The outcomes measured were the pooled rates of all adverse events (AEs), pooled rates of early AEs and pooled rates of delayed AEs. Results: A total of 8 studies (393 patients) were included. The pooled rate of all AEs was 12.7% (95% CI 8.4-18.7, I2= 7.7) compared to 17.5% (95% CI 10.2-28.2, I2= 65.1) with other SEMS, P = 0.39. The rate of early AEs with LAMS in endoscopic ultrasound-GBD (EUS-GBD) was 6.5% (95% CI 4.2-10, I2= 1.2), and the rate of delayed AEs was 8.3% (95% CI 5.8-11.9, I2 = 4.8). The rate of recurrent cholecystitis and/or cholangitis was 4.6% (95% CI 2.6-9.5, I2= 0) and the pooled rate of death was 5% (95% CI 2.6-9.5, I2 = 36.4). Conclusion: We report an overall AE rate of 13% with LAMS in EUS-GBD. Early AE risk appears to be 6.5% and delayed AE risk appears to be 8%. Our results are analyzed out of good-quality studies, with minimal to zero heterogeneity.


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