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Efficacy and Safety of Endoscopic Ultrasound-guided Choledochoduodenostomy

A Systematic Review and Meta-Analysis

Mohan, Babu P., MD*; Shakhatreh, Mohammed, MD; Garg, Rajat, MD; Ponnada, Suresh, MD, MPH§; Navaneethan, Udayakumar, MD; Adler, Douglas G., MD, FACG, AGAF, FASGE

Journal of Clinical Gastroenterology: April 2019 - Volume 53 - Issue 4 - p 243–250
doi: 10.1097/MCG.0000000000001167

Introduction: Endoscopic retrograde cholangiopancreatography is the preferred method in biliary drainage. Endoscopic ultrasound (EUS) guidance has shown tremendous success in situations where endoscopic retrograde cholangiopancreatography fails or is contraindicated. EUS-guided choledochoduodenostomy (CDD) in particular is gathering a lot of interest due to its ease, and high rates of success. The reported adverse events with this procedure have been inconsistent among studies.

Methods: We conducted a search of multiple electronic databases and conference proceedings from inception through June 2018. The primary outcome was to estimate the risk of adverse events, and the commonly reported subtype of adverse events in EUS-CDD. The secondary outcome was to estimate the pooled technical and clinical success rates.

Results: Thirteen studies including 572 patients underwent biliary drainage with EUS-CDD. The pooled rate of all adverse events was 0.136 (95% confidence interval, 0.097-0.188; P=0.01) with moderate heterogeneity (I2=56.9), and pooled rate of cholangitis was 4.2%, bleeding was 4.1%, bile leak was 3.7%, and perforation was 2.9%. On subgroup analysis, the pooled rate of adverse events with the use of lumen-apposing metal stent was 9.3% (95% confidence interval, 4.8-17.3).

Conclusions: On the basis of our analysis EUS-CDD has an adverse event risk of 13.4%, which is lowest reported in literature so far. Reported adverse rates appeared to be lower with the use of lumen-apposing metal stent, except for perforation.

*University of Alabama, DCH Medical Center, Tuscaloosa, AL

Rapides Regional Medical Center, Alexandria, LA

Cleveland Clinic Foundation, Cleveland, OH

§Carilion Roanoke Memorial Hospital, Roanoke, VA

Center for Interventional Endoscopy, Florida Hospital, Orlando, FL

Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT

The authors declare that they have nothing to disclose.

Address correspondence to: Douglas G. Adler, MD, FACG, AGAF, FASGE, GI fellowship Program, Department of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, Salt Lake City, UT 84132 (e-mail:

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