Objective: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a promising alternative for biliary decompression in patients with malignant distal biliary obstruction (MDBO), used either as a first-line approach or after other interventions have failed. This study aimed to evaluate the aggregated efficacy and safety of EUS-GBD in this patient population.Methods: A comprehensive literature search was carried out across PubMed/Medline, Embase, and Cochrane databases up to 9 January 2024, to identify studies reporting outcomes of EUS-GBD in MDBO cases. The primary endpoint assessed was clinical success, while secondary endpoints included technical success and the incidence of adverse events (AEs). Pooled outcomes were calculated using a random-effects model and presented with 95% confidence intervals (CIs).Results: Seven studies encompassing a total of 193 patients were included in the analysis. The combined clinical success rate for EUS-GBD was 88.1% [95% CI: 78.9–94.9%], while the technical success rate was 99.2% [95% CI: 97.5–100%]. The overall AE rate was 13.7% [95% CI: 9.3–18.8%], with the majority being mild to moderate in severity; no fatal complications were reported. Subgroup analyses indicated that use of smaller lumen-apposing metal stents (LAMS) (<15 mm) was associated with slightly higher clinical success (93.3% [95% CI: 72.4–99.9%]) compared to larger stents (≥15 mm) (87.1% [95% CI: 78.8–93.5%]), and a marginally lower rate of AEs (12.3% [95% CI: 6.4–19.7%] vs. 15.2% [95% CI: 6.5–26.6%]).Conclusions: EUS-GBD demonstrates excellent technical performance, high clinical efficacy, and a manageable safety profile in patients with MDBO and a patent cystic duct.
目的：超声内镜引导下胆囊引流术（EUS-GBD）已成为恶性远端胆道梗阻（MDBO）患者胆道减压的一种有前景的替代方案，可作为一线治疗或在其他干预失败后使用。本研究旨在评估EUS-GBD在该患者群体中的综合疗效和安全性。 方法：截至2024年1月9日，对PubMed/Medline、Embase和Cochrane数据库进行了全面的文献检索，以识别报告MDBO病例中EUS-GBD结局的研究。评估的主要终点是临床成功率，次要终点包括技术成功率和不良事件（AEs）发生率。使用随机效应模型计算汇总结果，并给出95%置信区间（CIs）。 结果：分析共纳入7项研究，总计193名患者。EUS-GBD的汇总临床成功率为88.1% [95% CI: 78.9–94.9%]，技术成功率为99.2% [95% CI: 97.5–100%]。总体不良事件发生率为13.7% [95% CI: 9.3–18.8%]，其中大多数为轻度至中度；未报告致命并发症。亚组分析表明，与较大支架（≥15 mm）相比，使用较小管径的覆膜金属支架（LAMS）（<15 mm）具有略高的临床成功率（93.3% [95% CI: 72.4–99.9%] vs. 87.1% [95% CI: 78.8–93.5%]）和稍低的不良事件发生率（12.3% [95% CI: 6.4–19.7%] vs. 15.2% [95% CI: 6.5–26.6%]）。 结论：对于胆囊管通畅的MDBO患者，EUS-GBD表现出卓越的技术性能、较高的临床疗效和可控的安全性。
肿瘤(癌症)患者之家