P0028 - Use of Fully Covered Self-Expanding Metal Stents for Management of Choledocholithiasis: A Systematic Review and Meta-Analysis

Maan El Halabi, MD¹, Bing Chen, MD², Christopher A. Gold, DO¹, Rose Walsh, ³, Yervant Ichkhanian, MD⁴, Angad Uberoi, MBBS¹, Nikhil A. Kumta, MD, MS^5
1Mount Sinai St. Luke's and Mount Sinai Roosevelt, New York, NY; ²Mount Sinai Morningside and West Hospitals, New York, NY; ³Icahn School of Medicine at Mount Sinai, New York, NY; ⁴Johns Hopkins University Hospital, Baltimore, MD; ⁵Mount Sinai Hospital, New York, NY

Introduction: Around 10% to 15% of common bile duct (CBD) stones may be difficult to remove, with several reported treatment options available. More recently, reports have suggested the use of removable fully covered self-expanding metal stents (FCSEMS) in the management of difficult CBD stones with rates around 82% and minimal adverse events. Our aim was to assess the efficacy and the safety of FCSEMS in managing difficult-to-treat choledocholithiasis.

Methods: This study was conducted in accordance with the recommendations outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Medline (Ovid) and Embase (Ovid) databases were searched from inception through September 2020, using a combination of subject headings and relevant keywords to yield any randomized control trial (RCT) or observational studies that address the use of metal stents in the management of choledocholithiasis. All results were screened by two independent reviewers. A total of 6 studies were selected for inclusion. Outcomes of interest were technical and clinical success, complete duct clearance rate, adverse events including stent related complications. Meta-analysis was performed using the Random effects model in Comprehensive Meta-Analysis.

Results: Six retrospective cohort studies were selected (183 patients). The FCSEMS placement was 100% successful in all included studies. The average duration for a stent in place before extraction is 111.6 days. Our results showed a stent extract rate of 96.3% (95%CI: 90.5%-98.6%), P< 0.001; I2=0. Duct clearance rate of 96.3% (95%CI: 90.5%-98.6%), P< 0.001; heterogeneity between studies with I2=62.9., and stent migration rate of 14.2% (95%CI: 8.0%-24.1%), P=0.144; heterogeneity between studies with I2=39.195. As for adverse events, meta-analysis showed a post-ERCP pancreatitis rate of 7.0% (95%CI: 4.0%-12.1%), P=0.855; heterogeneity between studies with I2=0. The meta-analysis showed a cholecystitis rate of 4.3 % (95%CI: 2.0%-8.7%), P< 0.001, I2=0; a cholangitis rate of 2.2% (95%CI: 0.8%-6.2%), P< 0.001, I2=0; a bleeding rate of 5.7% (P< 0.001, I2=0); and a bile duct perforation/bile leak rate of 3.2% (P< 0.001, I2=0).

Discussion: FCSEMS is a promising option for patients with complex biliary stone disease, allowing adequate biliary drainage and successful clearance in most patients. Due to the higher cost and limited large, randomized studies, more data is required for a better individualized and cost-effective patient approach.



Disclosures:


Maan El Halabi, MD¹, Bing Chen, MD², Christopher A. Gold, DO¹, Rose Walsh, ³, Yervant Ichkhanian, MD⁴, Angad Uberoi, MBBS¹, Nikhil A. Kumta, MD, MS⁵. P0028 - Use of Fully Covered Self-Expanding Metal Stents for Management of Choledocholithiasis: A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.