Vol.:(0123456789) 1 3 Surgical Endoscopy https://doi.org/10.1007/s00464-020-07484-w REVIEW ARTICLE Effectiveness and safety of EUS‑guided choledochoduodenostomy using lumen‑apposing metal stents (LAMS): a systematic review and meta‑analysis Rajesh Krishnamoorthi 1  · Chandra S. Dasari 2  · Viveksandeep Thoguluva Chandrasekar 2,3  · Harshith Priyan 4  · Mahendran Jayaraj 5  · Joanna Law 1  · Michael Larsen 1  · Richard Kozarek 1  · Andrew Ross 1  · Shayan Irani 1 Received: 23 July 2019 / Accepted: 26 February 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Background Endoscopic ultrasound-guided choledochoduodenostomy (CDD) is emerging as an alternative technique for biliary drainage in patients who fail conventional endoscopic retrograde cholangiopancreatography (ERCP). The lumen- apposing metal stents (LAMS) are being increasingly used for CDD. We performed a systematic review and meta-analysis to evaluate the effectiveness and safety of CDD using LAMS. Methods We performed a systematic search of multiple databases through May 2019 to identify studies on CDD using covered self-expanding metal stents. Pooled rates of technical success, clinical success, adverse events, and recurrent jaun- dice associated with CDD using LAMS were estimated. A subgroup analysis was performed based on use of LAMS with electrocautery-enhanced delivery system (EC-LAMS). Results Seven studies on CDD using LAMS (with 284 patients) were included in the meta-analysis. Pooled rates of technical and clinical success (per-protocol analysis) were 95.7% (95% CI 93.2–98.1) and 95.9% (95% CI 92.8–98.9), respectively. Pooled rate of post-procedure adverse events was 5.2% (95% CI 2.6–7.9). Pooled rate of recurrent jaundice was 8.7% (95% CI 4.5–12.8). On subgroup analysis of CDD using EC-LAMS (5 studies with 201 patients), the pooled rates of technical and clinical suc- cess (per-protocol analysis) were 93.8% (95% CI 90.4–97.1) and 95.9% (95% CI 91.9–99.9), respectively. Pooled rate of post-procedure adverse events was 5.6% (95% CI 1.7–9.5). Pooled rate of recurrent jaundice was 11.3% (95% CI 6.9–15.7). Heterogeneity (I 2 ) was low to moderate in the analyses. Conclusion CDD using LAMS/EC-LAMS is an effective and safe technique for biliary decompression in patients who failed ERCP. Further studies are needed to assess CDD using LAMS as primary treatment modality for biliary obstruction. Keywords LAMS- lumen-apposing metal stents · EC-LAMS- electro-cautery-enhanced LAMS · Malignant biliary obstruction · Technical and clinical success · Adverse events In patients with malignant biliary obstruction, endoscopic retrograde cholangiopancreatography (ERCP) is the first line management to restore biliary drainage [1]. When bil- iary cannulation fails with conventional ERCP, percutane- ous transhepatic biliary drainage (PTBD) performed by and Other Interventional Techniques Rajesh Krishnamoorthi and Chandra S. Dasari shares co-first authorship Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-07484-w) contains supplementary material, which is available to authorized users. * Rajesh Krishnamoorthi Rajesh.Krishnamoorthi@virginiamason.org 1 Virginia Mason Medical Center, Digestive Diseases Institute, Seattle, WA, USA 2 Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, USA 3 University of Kansas Medical Center, Kansas City, KS, USA 4 Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA 5 University of Nevada, Las Vegas, NV, USA