Pub Date : 2026-03-03DOI: 10.1016/j.gie.2026.02.044
Saurabh Chandan, Tareq Alsaleh, Douglas G. Adler
BACKGROUND AND AIMSWhen endoscopic retrograde cholangiopancreatography (ERCP) is not feasible or fails in palliation of malignant distal biliary obstruction (MDBO), EUS-guided choledochoduodenostomy (EUS-CDS) and EUS-guided gallbladder drainage (EUS-GBD) are viable alternatives. We conducted a systematic review and meta-analysis comparing safety and efficacy of the two techniques for palliation of MDBO.METHODSMultiple databases were searched through November 2025 for studies that reported outcomes of EUS-CDS and EUS-GDB in patients with MDBO. Meta-analysis was performed to determine pooled proportions and relative risk (RR) with 95% confidence intervals (CI). We compared the rates of technical and clinical success, overall adverse events (AEs) and lumen-apposing metal stent (LAMS) dysfunction. Random-effects model was used for our meta-analysis and heterogeneity was assessed using the I2% statistics.RESULTSFive studies (352 patients; EUS-CDS: 193, EUS-GBD: 159) were included. Technical success was 93.3% (CI 70.6-98.8) for EUS-CDS and 95.9% (CI 90.0-98.4) for EUS-GBD (RR 1.02; CI 0.94-1.10; p=0.6). Clinical success was 90.1% (CI 84.7-93.7) vs 86.6% (CI 80.3-91.0) (RR 0.97; CI 0.90-1.05; p=0.4). There were no significant differences in overall adverse events (19.7% vs 17.6%; RR 0.93; CI 0.58-1.48; p=0.8), severe adverse events (11.0% vs 8.3%; RR 0.69; CI 0.33-1.44; p=0.3), or stent dysfunction (15.0% vs 14.5%; RR 0.95; CI 0.35-2.58; p=0.9).CONCLUSIONEUS-GBD appears comparable to EUS-CDS in terms of technical and clinical success, adverse events, and stent dysfunction. Further prospective studies are warranted to corroborate our findings.
背景和目的当内镜逆行胆管造影（ERCP）不可行或不能缓解恶性胆道远端梗阻（MDBO）时，eus引导下的胆总管十二指肠吻合术（EUS-CDS）和eus引导下的胆囊引流术（EUS-GBD）是可行的选择。我们进行了一项系统综述和荟萃分析，比较了两种缓解MDBO的技术的安全性和有效性。方法检索截至2025年11月的多个数据库，查找报告MDBO患者EUS-CDS和EUS-GDB结果的研究。进行meta分析以确定合并比例和相对风险（RR）， 95%置信区间（CI）。我们比较了技术和临床成功率、总不良事件（ae）和腔旁金属支架（LAMS）功能障碍的比率。meta分析采用随机效应模型，采用I2%统计量评估异质性。结果纳入5项研究（352例，其中EUS-CDS 193例，EUS-GBD 159例）。EUS-CDS的技术成功率为93.3% (CI 70.6-98.8)， EUS-GBD的技术成功率为95.9% (CI 90.0-98.4) （RR 1.02; CI 0.94-1.10; p=0.6）。临床成功率为90.1% (CI 84.7-93.7) vs 86.6% (CI 80.3-91.0) （RR 0.97; CI 0.90-1.05; p=0.4）。总不良事件（19.7% vs 17.6%; RR 0.93; CI 0.58-1.48; p=0.8）、严重不良事件（11.0% vs 8.3%; RR 0.69; CI 0.33-1.44; p=0.3）或支架功能障碍（15.0% vs 14.5%; RR 0.95; CI 0.35-2.58; p=0.9）方面无显著差异。结论eus - gbd在技术和临床成功、不良事件和支架功能障碍方面与EUS-CDS相当。需要进一步的前瞻性研究来证实我们的发现。
{"title":"EFFICACY AND SAFETY OF ENDOSCOPIC ULTRASOUND-GUIDED CHOLEDOCHODUODENOSTOMY COMPARED WITH ENDOSCOPIC ULTRASOUND-GUIDED GALLBLADDER DRAINAGE FOR PALLIATION OF MALIGNANT DISTAL BILIARY OBSTRUCTION: A SYSTEMATIC REVIEW AND META ANALYSIS","authors":"Saurabh Chandan, Tareq Alsaleh, Douglas G. Adler","doi":"10.1016/j.gie.2026.02.044","DOIUrl":"https://doi.org/10.1016/j.gie.2026.02.044","url":null,"abstract":"BACKGROUND AND AIMSWhen endoscopic retrograde cholangiopancreatography (ERCP) is not feasible or fails in palliation of malignant distal biliary obstruction (MDBO), EUS-guided choledochoduodenostomy (EUS-CDS) and EUS-guided gallbladder drainage (EUS-GBD) are viable alternatives. We conducted a systematic review and meta-analysis comparing safety and efficacy of the two techniques for palliation of MDBO.METHODSMultiple databases were searched through November 2025 for studies that reported outcomes of EUS-CDS and EUS-GDB in patients with MDBO. Meta-analysis was performed to determine pooled proportions and relative risk (RR) with 95% confidence intervals (CI). We compared the rates of technical and clinical success, overall adverse events (AEs) and lumen-apposing metal stent (LAMS) dysfunction. Random-effects model was used for our meta-analysis and heterogeneity was assessed using the I2% statistics.RESULTSFive studies (352 patients; EUS-CDS: 193, EUS-GBD: 159) were included. Technical success was 93.3% (CI 70.6-98.8) for EUS-CDS and 95.9% (CI 90.0-98.4) for EUS-GBD (RR 1.02; CI 0.94-1.10; p=0.6). Clinical success was 90.1% (CI 84.7-93.7) vs 86.6% (CI 80.3-91.0) (RR 0.97; CI 0.90-1.05; p=0.4). There were no significant differences in overall adverse events (19.7% vs 17.6%; RR 0.93; CI 0.58-1.48; p=0.8), severe adverse events (11.0% vs 8.3%; RR 0.69; CI 0.33-1.44; p=0.3), or stent dysfunction (15.0% vs 14.5%; RR 0.95; CI 0.35-2.58; p=0.9).CONCLUSIONEUS-GBD appears comparable to EUS-CDS in terms of technical and clinical success, adverse events, and stent dysfunction. Further prospective studies are warranted to corroborate our findings.","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"43 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147359499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-09-15DOI: 10.1016/j.gie.2025.09.016
Jad P. AbiMansour MD, Manik Aggarwal MBBS, Hadi Abou Zeid MD, Elizabeth Rajan MD, Andrew C. Storm MD
Background and Aims
Interventional EUS has allowed for the endoscopic management of conditions that previously required abdominal surgery, including transmural drainage of the gallbladder (EUS-GBD). These procedures are technically demanding and can be associated with serious adverse events. The aim of this study was to establish the feasibility and safety of a novel endosonography-guided suturing device, which allows apposition of the gastrointestinal lumen and gallbladder for EUS-GBD, reducing technical demands and improving safety.
Methods
A preclinical survival study was conducted on 6 domestic pigs. Animals were randomized in a 2:1 ratio to undergo EUS-GBD with the suturing device preceding freehand lumen-apposing metal stent (LAMS) deployment or LAMS alone. Ease of device use, stent deployment, technical success, and intraprocedural adverse events were recorded. The animals were kept alive for 30 days, which was followed by euthanasia, necropsy, and histologic analysis.
Results
Technical success was achieved in all animals (4 suture + LAMS and 2 LAMS only). Suture fixation significantly decreased the distance from the gastrointestinal lumen to the gallbladder (17.6-6.7 mm, P = .001), allowing for successful LAMS deployment in all 4 cases without adverse events. One intraprocedural stent maldeployment was reported in the control group. No adverse events were identified in either group during the survival period or on necropsy.
Conclusions
This study demonstrates the safety and effectiveness of a novel device that allows for endoscopic anchoring of the gallbladder to the gastrointestinal lumen. This facilitated the successful completion of EUS-GBD and may have implications for other interventional EUS procedures.
背景和目的：介入内镜超声（EUS）允许在内镜下治疗以前需要腹部手术的疾病，包括胆囊经壁引流（EUS- gbd）。这些手术在技术上要求很高，并可能伴有严重的不良事件。本研究的目的是建立一种新型超声引导下的缝合装置的可行性和安全性，该装置允许对胃肠道管腔和胆囊进行EUS-GBD，减少技术要求并提高安全性。方法：采用6头家猪进行临床前生存研究。动物以2:1的比例随机分配，在徒手腔内金属支架（LAMS）部署之前使用缝合装置进行EUS-GBD或单独使用LAMS。记录器械使用的便利性、支架部署、技术成功和术中不良事件。动物存活30天，随后进行安乐死、尸检和组织学分析。结果：所有动物均获得技术成功（4只缝合+LAMS， 2只LAMS）。缝线固定显著缩短了从胃肠道管腔到胆囊的距离（17.6至6.7mm, p =0.001），使得所有4例患者均成功部署了LAMS，无不良事件发生。对照组报告1例术中支架放置不当。两组患者在生存期或尸检时均未发现不良事件。结论：本研究证明了一种新型装置的安全性和有效性，该装置允许在内镜下将胆囊锚定到胃肠道管腔。这促进了EUS- gbd的成功完成，并可能对其他介入EUS手术产生影响。
{"title":"Transmural gallbladder drainage using a novel endosonographic-guided suture (with video)","authors":"Jad P. AbiMansour MD, Manik Aggarwal MBBS, Hadi Abou Zeid MD, Elizabeth Rajan MD, Andrew C. Storm MD","doi":"10.1016/j.gie.2025.09.016","DOIUrl":"10.1016/j.gie.2025.09.016","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Interventional EUS has allowed for the endoscopic management of conditions that previously required abdominal surgery, including transmural drainage of the gallbladder (EUS-GBD). These procedures are technically demanding and can be associated with serious adverse events. The aim of this study was to establish the feasibility and safety of a novel endosonography-guided suturing device, which allows apposition of the gastrointestinal lumen and gallbladder for EUS-GBD, reducing technical demands and improving safety.</div></div><div><h3>Methods</h3><div>A preclinical survival study was conducted on 6 domestic pigs. Animals were randomized in a 2:1 ratio to undergo EUS-GBD with the suturing device preceding freehand lumen-apposing metal stent (LAMS) deployment or LAMS alone. Ease of device use, stent deployment, technical success, and intraprocedural adverse events were recorded. The animals were kept alive for 30 days, which was followed by euthanasia, necropsy, and histologic analysis.</div></div><div><h3>Results</h3><div>Technical success was achieved in all animals (4 suture + LAMS and 2 LAMS only). Suture fixation significantly decreased the distance from the gastrointestinal lumen to the gallbladder (17.6-6.7 mm, <em>P</em> = .001), allowing for successful LAMS deployment in all 4 cases without adverse events. One intraprocedural stent maldeployment was reported in the control group. No adverse events were identified in either group during the survival period or on necropsy.</div></div><div><h3>Conclusions</h3><div>This study demonstrates the safety and effectiveness of a novel device that allows for endoscopic anchoring of the gallbladder to the gastrointestinal lumen. This facilitated the successful completion of EUS-GBD and may have implications for other interventional EUS procedures.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"103 3","pages":"Pages 597-602.e10"},"PeriodicalIF":7.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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