EUS-Guided Choledochoduodenostomy with Lumen-Apposing Metal Stent versus ERCP with Self-Expandable Metal Stent as Primary Biliary Drainage for Malignant Distal Biliary Obstruction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The study compared two methods for treating malignant distal biliary obstruction: EUS-guided choledochoduodenostomy with lumen-apposing metal stent (LAMS) and ERCP with self-expandable metal stent (SEMS). The analysis included three high-quality randomized controlled trials with a total of 519 patients. Results showed that the EUS method with LAMS had higher technical success (18 percent higher), shorter procedure time, and lower risk of post-procedure pancreatitis compared to ERCP. Clinical success and overall adverse events were comparable between both methods. The results were confirmed by sensitivity analysis and sequential meta-analysis. Based on these findings, EUS-guided choledochoduodenostomy with LAMS may be considered as an alternative method for primary biliary drainage.