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
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Background
Whether endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with lumen-apposing metal stent (LAMS) is superior to endoscopic retrograde cholangiopancreatography (ERCP) with self□expandable metal stent (SEMS) as primary drainage for malignant distal biliary obstruction (MDBO) remains uncertain. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare their efficacy and safety.
Methods
A systematic search of CENTRAL, PubMed, and Embase through September 11, 2026 was conducted. GRADE and trial sequential analysis (TSA) were performed.
Results
Three high-quality RCTs comprising 519 patients were included. Moderate-certainty evidence showed EUS-CDS with LAMS was associated with higher technical success (RR 1.18, 95% CI 1.09–1.28, P < 0.0001), shorter procedure time (P<0.00001), and lower postprocedural pancreatitis risk (P = 0.01) than ERCP, with comparable clinical success and overall adverse events. Sensitivity analysis, cumulative meta-analysis, and TSA supported the results.
Conclusions
EUS-CDS with LAMS may be considered as an alternative primary biliary drainage for MDBO.
