Published online Jul 27, 2024. doi: 10.4240/wjgs.v16.i7.1956
Revised: April 25, 2024
Accepted: May 13, 2024
Published online: July 27, 2024
Processing time: 146 Days and 22.8 Hours
This editorial delves into Peng et al's article, published in the World Journal of Gastrointestinal Surgery. Peng et al's meta-analysis investigates the effectiveness of electrocautery-enhanced lumen-apposing metal stents (ECE-LAMS) in ultrasou
Core Tip: This meta-analysis highlights the effectiveness of electrocautery-enhanced lumen-apposing metal stents (ECE-LAMS) in ultrasound-guided biliary drainage for malignant obstruction. Based on diverse studies, it demonstrates a strong technical success rate of 96.7%, showcasing ECE-LAMS' efficacy in challenging cases post-failed endoscopic retrograde cholangio pancreatography. The notably high clinical success rate underscores its impact on symptom relief, and the safety profile is deemed acceptable. However, the observed adverse events and re-intervention rate emphasize the importance of vigilant post-procedural monitoring. Consistent outcomes across subgroups enhance the applicability of ECE-LAMS, po
- Citation: Chisthi MM. Unveiling the potential of electrocautery-enhanced lumen-apposing metal stents in endoscopic ultrasound-guided biliary drainage. World J Gastrointest Surg 2024; 16(7): 1956-1959
- URL: https://www.wjgnet.com/1948-9366/full/v16/i7/1956.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v16.i7.1956
In patients with obstruction of distal biliary tree attributed to malignant etiology, endoscopic retrograde cholangio pancreatography (ERCP) is the preferred fashion for bile duct drainage. However, where ERCP fails, alternate methods need to be explored. Endoscopic ultrasound-guided-biliary drainage (EUS-BD) has turned out to be a useful option for managing malignancy-induced biliary obstruction, especially when conventional options like ERCP face challenges[1]. A significant advancement related to biliary drainage by endoscopy is the application of electrocautery-enhanced lumen-apposing metal-stents (ECE-LAMS), a technology with the potential to improve the procedural success and safety of the technique[2]. This stent allows for biliary-enteric anastomosis under endoscopic ultrasound (EUS) guidance in a single step itself, obviating the need for previous bile duct puncturing or guide-wire insertion.
In the past, surgical bypass or percutaneous trans-hepatic biliary-drainage (PTBD) was deemed to be the best method for providing palliation in case of patients in whom ERCP is found to be unsuccessful for malignant biliary obstruction. While surgical biliary bypass did demonstrate effective technical success, it was frequently associated with a significant occurrence of major adverse events and even mortality. On the other hand, PTBD, while demonstrating technical success, ended up with a high rate of complications and negatively affected health- related quality of life, with an adverse event rate reaching even up to 60%. Conventional approaches to biliary drainage, such as plastic stents and uncovered metal stents, frequently pose limitations, especially in cases of failed ERCP. ECE- LAMS, on the other hand, offers a new so
While former studies have explored the varied aspects of EUS-BD, the specific focus on ECE-LAMS and its potential implications in endoscopic methods for biliary obstruction demand devoted attention[5]. This manuscript endeavors to extensively review the current literature, synthesizing evidence from pertinent studies, to give a nuanced understanding of the safety, efficacy and clinical mileage of ECE-LAMS in the realm of EUS-BD[6,7]. In exploring this content, it's im
This review seeks to consolidate the evidence surrounding ECE-LAMS in EUS-BD, drawing from different sets of studies that explore its operations in various clinical scenarios. The references cited herein represent a comprehensive array of exploration that delves into different elements of EUS-guided interventions, which includes the variety of stent designs, procedural variations, and comparative analyses against traditional approaches. A former systematic review has carried out a critical appraisal of published papers on EUS-guided interventions[9]. Nevertheless, the current exploration specifically focuses on the aspect of ECE-LAMS for palliating malignant biliary obstructions[10]. This is an update and improvement on the systematic review and meta-analysis which was published by the same authors in 2021[11]. In the meta-analysis, a comprehensive examination was accepted to assess the methodological strengths, pivotal findings, and practical implications picked from the named studies. Additionally, the research extended to the clinical implications of these findings, contemplating how they can be restated into real- world operations and provide guidance for medical practitioners in their decision- making processes.
The meta-analysis conducted by Peng et al[10] intends to provide an updated and comprehensive evaluation of the ef
This meta-analysis, incorporating data from a diverse set of studies, sheds light on crucial aspects that influence the clinical utility of this evolving technique. One notable strength shown by the meta-analysis is that they have included 14 eligible studies, involving a total of 620 participants. This extensive data pool adds to the statistical power of the findings from the analysis and provides a more robust foundation for drawing meaningful observations about the usefulness of ECE-LAMS in the setting of biliary drainage. The meta-analysis reveals a commendable pooled technical success rate at 96.7%, indicating the efficacy of ECE-LAMS in achieving effective biliary drainage in a significant number of cases. This high procedural success rate underscores the precision and reliability of the electrocautery-enhanced approach in esta
Safety is a paramount concern in any medical intervention, and the meta-analysis addresses this by reporting adverse events in 17.5% of patients. The documented adverse events contribute valuable insights into the safety profile of ECE-LAMS, allowing clinicians to weigh the benefits against potential risks in the decision-making process. Re-intervention rates, an essential aspect in evaluating the durability of the procedure, are reported at 7.3%. This moderate rate suggests that while ECE-LAMS demonstrates favorable success, a subset of patients may require further interventions. Comprehending the reasons behind re-interventions is crucial for refining the procedural approach and optimizing patient outcomes. Subgroup analyses performed in the meta-analysis demonstrate consistent results across various parameters, further contributing to the generalisability of the findings. This consistency suggests that the favorable outcomes ob
This research does have its own set of limitations. The absence of a consistent definition for clinical success may contribute to a medium level of heterogeneity. Also, subgroup analyses were hindered by the original study designs (in
The outcomes depicted by this meta-analysis establish a robust groundwork for influencing the trajectory of future research and enhancing clinical practices. The positive results observed with ECE-LAMS underscore the need for further exploration into its long-term effectiveness, identification of optimal patient selection criteria, and potential refinements in procedural techniques. Clinicians must stay informed about the evolving evidence and actively engage in the ongoing discourse regarding the seamless integration of ECE-LAMS into routine clinical practice. This continuous involvement will not only contribute to the advancement of knowledge but also foster improved patient outcomes in the realm of biliary interventions.
In conclusion, Peng et al's meta-analysis[10] provides a comprehensive and contemporary overview of the performance of ECE-LAMS in endoscopic biliary-drainage for biliary obstruction due to malignant causes. The very good technical tri
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