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Determinants of outcomes of transmural EUS-guided gallbladder drainage: systematic review with proportion meta-analysis and meta-regression

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Abstract

Background and aims

Transmural EUS-guided gallbladder drainage (EUS-GBD) has been increasingly used in the treatment of gallbladder diseases. Aims of the study were to provide a comprehensive meta-analysis and meta-regression of features and outcomes of this procedure.

Methods

MEDLINE, Scopus, Web of science, and Cochrane databases were searched for literature pertinent to transmural EUS-GBD up to May 2021. Random-effect meta-analysis of proportions and meta-regression of potential modifiers of outcome measures considered were applied. Outcome measures were technical success rate, overall clinical success, and procedure-related adverse events (AEs).

Results

Twenty-seven articles were identified including 1004 patients enrolled between February 2009 and February 2020. Acute cholecystitis was present in 98.7% of cases. Pooled technical success was 98.0% (95% CI 96.3, 99.3; heterogeneity: 23.6%), the overall clinical success was 95.4% (95% CI 92.8, 97.5; heterogeneity: 35.3%), and procedure-related AEs occurred in 14.8% (95% CI 8.8, 21.8; heterogeneity: 82.4%), being stent malfunction/dislodgement the most frequent (3.5%). Procedural-related mortality was 1‰. Meta-regression showed that center experience proxied to > 10 cases/year increased the technical success rate (odds ratio [OR]: 2.84; 95% CI 1.06, 7.59) and the overall clinical success (OR: 3.52; 95% CI 1.33, 9.33). The use of anti-migrating devices also increased the overall clinical success (OR: 2.16; 95% CI 1.07, 4.36) while reducing procedure-related AEs (OR: 0.36; 95% CI 0.14, 0.98).

Conclusion

Physicians’ experience and anti-migrating devices are the main determinants of main clinical outcomes after EUS-GBD, suggesting that treatment in expert centers would optimize results.

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Authors and Affiliations

  1. Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, Ausl Romagna, Forlì-Cesena, Italy

    Carlo Fabbri, Cecilia Binda, Monica Sbrancia, Elton Dajti & Chiara Coluccio

  2. Department of Medical and Surgical Sciences – DIMEC, Alma Mater Studiorum – Univeristy of Bologna, Bologna, Italy

    Giorgio Ercolani & Alessandro Cucchetti

  3. Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy

    Giorgio Ercolani & Alessandro Cucchetti

  4. Division of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy

    Andrea Anderloni

  5. Gastroenterologia ed Endoscopia Digestiva, Ospedale Morgagni – Pierantoni, Via Carlo Forlanini, 34, 47121, Forlì, FC, Italy

    Cecilia Binda

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  1. Carlo Fabbri
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Contributions

CF conceived the hypothesis, planned the study and wrote the manuscript; CB, MS and ED collected data, helped in interpreting results and in manuscript preparation; CC provided quality assessment and final data check for inclusion in the analysis. GE and AA helped in manuscript writing providing important intellectual contents. AC coordinated the study and performed statistical analyses.

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Correspondence to Cecilia Binda.

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Carlo Fabbri is a consultant for Boston Scientific; Andrea Anderloni is a consultant for Medtronic, Boston Scientific, and Olympus. Cecilia Binda, Monica Sbrancia, Elton Dajti, Chiara Coluccio, Giorgio Ercolani, and Alessandro Cucchetti have no financial ties to disclose. The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Fabbri, C., Binda, C., Sbrancia, M. et al. Determinants of outcomes of transmural EUS-guided gallbladder drainage: systematic review with proportion meta-analysis and meta-regression. Surg Endosc 36, 7974–7985 (2022). https://doi.org/10.1007/s00464-022-09339-y

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