{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:32:50Z","timestamp":1790778770445,"version":"4.1.0"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) has emerged as an alternative to endoscopic retrograde cholangiopancreatography (ERCP) for biliary drainage in patients with malignant distal biliary obstruction (MDBO). With cautery-enhanced lumen-apposing metal stents (CE-LAMSs), EUS-CDS has become more feasible, yet concerns remain regarding stent patency and safety. Comparative data between CE-LAMS-based and conventional self-expandable metal stent (SEMS)-based EUS-CDS are lacking. The aim of this analysis was to compare outcomes between the two EUS-CDS strategies using ERCP as a common comparator.<\/jats:p>\n                  <jats:p>A systematic review and network meta-analysis was conducted including randomized controlled trials (RCTs) comparing EUS-CDS using a CE-LAMS or SEMS with ERCP in MDBO. Procedural outcomes were technical success and procedure time; clinical outcomes included clinical success, adverse events (AEs), and cholangitis. Pairwise and network meta-analyses were performed using random-effects models. Ranking probabilities were assessed using the surface under the cumulative ranking curve (SUCRA).<\/jats:p>\n                  <jats:p>6 RCTs (707 patients) were included in the analysis. EUS-CDS with CE-LAMS demonstrated significantly higher technical success compared with SEMS-based EUS-CDS (risk ratio [RR] 1.22, 95%CI 1.10 to 1.36) and ERCP (RR 1.18, 95%CI 1.10 to 1.27). It was also associated with shorter procedure time compared with SEMS-based EUS-CDS (standardized mean difference [SMD] \u22120.78, 95%CI \u22121.30 to \u22120.27) and ERCP (SMD \u22120.84, 95%CI \u22121.16 to \u22120.52). No significant differences in clinical success or AEs were found between techniques. According to SUCRA, CE-LAMS ranked highest for technical success and procedural time, while SEMS-based EUS-CDS showed the lowest risk of overall AEs and cholangitis.<\/jats:p>\n                  <jats:p>EUS-CDS with CE-LAMS offers superior procedural efficiency compared with ERCP and SEMS-based approaches with similar clinical success and safety, although concerns about cholangitis warrant further evaluation.<\/jats:p>\n                  <jats:p>PROSPERO registration number: CRD420251126733.<\/jats:p>","DOI":"10.1055\/a-2817-3705","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T23:00:39Z","timestamp":1776466839000},"page":"710-718","source":"Crossref","is-referenced-by-count":3,"title":["Lumen-apposing metal stents vs. self-expandable metal stents for endoscopic ultrasound-guided choledochoduodenostomy: a network meta-analysis of randomized controlled trials"],"prefix":"10.1055","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3909-9012","authenticated-orcid":false,"given":"Marco","family":"Spadaccini","sequence":"additional","affiliation":[{"name":"Humanitas University, Italy","place":["Milan"],"department":["Biomedical Sciences"]},{"name":"IRCCS Humanitas Research Hospital, Lombardia, Italy","place":["Rozzano"],"department":["Endoscopy Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5704-2226","authenticated-orcid":false,"given":"Yen-I","family":"Chen","sequence":"additional","affiliation":[{"name":"McGill University Health Centre, Canada","place":["Montreal"],"department":["Division of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0477-4532","authenticated-orcid":false,"given":"Roy L.J.","family":"van Wanrooij","sequence":"additional","affiliation":[{"name":"Amsterdam UMC Locatie VUmc, Netherlands","place":["Amsterdam"],"department":["Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"Perez-Cuadrado-Robles","sequence":"additional","affiliation":[{"name":"Georges Pompidou European Hospital Anatomical Pathology, France","place":["Paris"],"department":["Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Colombo","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Lombardia, Italy","place":["Rozzano"],"department":["Endoscopy Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0485-4903","authenticated-orcid":false,"given":"Alessandro","family":"Fugazza","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Lombardia, Italy","place":["Rozzano"],"department":["Endoscopy Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6280-4176","authenticated-orcid":false,"given":"Shannon Melissa","family":"Chan","sequence":"additional","affiliation":[{"name":"The Chinese University of Hong Kong, Hong Kong","place":["Hong Kong"],"department":["Surgery, Prince of Wales Hospital"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00e9mie","family":"Albouys","sequence":"additional","affiliation":[{"name":"Hopital Dupuytren, France","place":["Limoges"],"department":["Hepatogastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3440-4981","authenticated-orcid":false,"given":"Gianluca","family":"Franchellucci","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Lombardia, Italy","place":["Rozzano"],"department":["Endoscopy Unit"]},{"name":"Humanitas Clinical and Research Center - IRCCS, Italy","place":["Rozzano"],"department":["IBD Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"De Marco","sequence":"additional","affiliation":[{"name":"Humanitas Gavazzeni, Italy","place":["Bergamo"],"department":["Endoscopic Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6448-2649","authenticated-orcid":false,"given":"Roberto","family":"De Sire","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Lombardia, Italy","place":["Rozzano"],"department":["Endoscopy Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daryl","family":"Ramai","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital, Massachusetts, United States","place":["Boston"],"department":["Division of Gastroenterology, Hepatology and Endoscopy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Fabbri","sequence":"additional","affiliation":[{"name":"Azienda Unita Sanitaria Locale della Romagna, Italy","place":["Forl\u00ec-Cesena"],"department":["Digestive Endoscopy and Gastroenterology Unit, Forl\u00ec-Cesena Hospitals"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1021-0031","authenticated-orcid":false,"given":"Andrea","family":"Anderloni","sequence":"additional","affiliation":[{"name":"Universit\u00e0 di Pavia, Italy","place":["Pavia"],"department":["Internal Medicine and Medical Therapeutics"]},{"name":"Fondazione IRCCS Policlinico San Matteo, Italy","place":["Pavia"],"department":["Gastroenterology and Endoscopy Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2107-2156","authenticated-orcid":false,"given":"Antonio","family":"Facciorusso","sequence":"additional","affiliation":[{"name":"Universit\u00e0 del Salento, Italy","place":["Lecce"],"department":["Experimental Medicine, Section of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesare","family":"Hassan","sequence":"additional","affiliation":[{"name":"Humanitas University, Italy","place":["Milan"],"department":["Biomedical Sciences"]},{"name":"IRCCS Humanitas Research Hospital, Lombardia, Italy","place":["Rozzano"],"department":["Endoscopy Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremie","family":"Jacques","sequence":"additional","affiliation":[{"name":"CHU Dupuytren Limoges, 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Khoury","year":"2024","journal-title":"Endoscopy"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1016\/j.gie.2017.08.017","article-title":"Long-term outcomes of EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction: a prospective multicenter study","volume":"87","author":"T Tsuchiya","year":"2018","journal-title":"Gastrointest Endosc"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.gie.2018.03.012","article-title":"Stent placement by EUS or ERCP for primary biliary decompression in pancreatic cancer: a randomized trial (with videos)","volume":"88","author":"JY Bang","year":"2018","journal-title":"Gastrointest Endosc"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1038\/s41395-018-0122-8","article-title":"EUS-guided biliary drainage versus ERCP for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical 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