Adverse events with lumen-apposing metal stents in endoscopic gallbladder drainage: A systematic review and meta-analysis

BACKGROUND: Lumen-apposing metal stents (LAMS) are rapidly being used in endoscopic interventional drainage procedures and have started to replace the self-expanding metal stents (SEMSs). Its use in gallbladder drainage (GBD) is limited by lack of good-quality studies, and data are scarce on its safety. METHODS: We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, Embase, and Web of Science databases (from inception through July 2018) to identify studies that reported on the use of LAMS in GBD. The outcomes measured were the pooled rates of all adverse events (AEs), pooled rates of early AEs and pooled rates of delayed AEs. RESULTS: A total of 8 studies (393 patients) were included. The pooled rate of all AEs was 12.7% (95% CI 8.4-18.7, I(2) = 7.7) compared to 17.5% (95% CI 10.2-28.2, I(2) = 65.1) with other SEMS, P = 0.39. The rate of early AEs with LAMS in endoscopic ultrasound-GBD (EUS-GBD) was 6.5% (95% CI 4.2-10, I(2) = 1.2), and the rate of delayed AEs was 8.3% (95% CI 5.8-11.9, I(2) = 4.8). The rate of recurrent cholecystitis and/or cholangitis was 4.6% (95% CI 2.6-9.5, I(2) = 0) and the pooled rate of death was 5% (95% CI 2.6-9.5, I(2) = 36.4). CONCLUSION: We report an overall AE rate of 13% with LAMS in EUS-GBD. Early AE risk appears to be 6.5% and delayed AE risk appears to be 8%. Our results are analyzed out of good-quality studies, with minimal to zero heterogeneity.