A systematic review and meta-analysis of metal versus plastic stents for drainage of pancreatic fluid collections: metal stents are advantageous

Saunders, Rebecca; Ramesh, Jayapal; Cicconi, Silvia; Evans, Jonathan; Yip, Vincent; Raraty, Michael; Ghaneh, Paula; Sutton, Robert; Neoptolemos, John P.; Halloran, Christopher

doi:10.1007/s00464-018-6416-5

Cited by 54 publications

(50 citation statements)

References 27 publications

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“…However, previous observations of the two stent types found them comparable without high-quality evidence to favor one over the other [48]. Indeed, meta-analyses on the topic have had variable results with more recent publications favoring metal stents over double pig-tail stents [49,50]. Nonetheless, these studies reported outcomes for PFC in general.…”

Section: Discussionmentioning

confidence: 96%

Endoscopic Transmural Drainage is Associated With Improved Outcomes in Disconnected Pancreatic Duct Syndrome: A Systematic Review and Meta-analysis

Pandanaboyana

Ratnayake

et al. 2020

Preprint

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BackgroundDisconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF). This systematic review and pairwise meta-analysis aim to review the definitions, clinical presentation, intervention, and outcomes for DPDS. MethodsThe PubMed, EMBASE, MEDLINE, and SCOPUS databases were systematically searched until February 2020 using the PRISMA framework. A meta-analysis was performed to assess the success rates of endoscopic and surgical interventions for the treatment of DPDS. Success of DPDS treatment was defined as long-term resolution of symptoms without recurrence of PFC, EPF, or pancreatic ascites.ResultsThirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.2%, 918/964), followed by chronic pancreatitis (3.1%, 30/964). DPDS commonly presented with PFC (77.3%,728/942) and EPF (18.6%, 175/942). There was significant heterogeneity in the definition of DPDS in the literature. Weighted success rate of endoscopic transmural drainage (90.6%, 95%-CI: 81.0-95.6%) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7-77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical intervention, which were 82% (weighted 95%-CI 68.6-90.5) and 87.4% (95%-CI 81.2-91.8), respectively (P=0.389). Conclusions Endoscopic transmural drainage was superior to transpapillary drainage for the management of DPDS. Endoscopic and surgical interventions had comparable success rates. The significant variability in the definitions and treatment strategies for DPDS warrant standardisation for further research.

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Section: Discussionmentioning

confidence: 96%

Endoscopic Transmural Drainage is Associated With Improved Outcomes in Disconnected Pancreatic Duct Syndrome: A Systematic Review and Meta-analysis

Pandanaboyana

Ratnayake

et al. 2020

Preprint

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“…In the recent years, the debate regarding the appropriate stent for EUS‐guided PFC drainage has again come into the spotlight. Several systematic reviews with traditional pairwise meta‐analysis comparing metal and plastic stents in EUS‐guided PFC drainage are available . Although these data showed that metal stents improved clinical outcomes and safety compared with plastic stents, some important questions remained unaddressed, such as which metal stent improves clinical outcomes and safety profiles.…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy of stents in endoscopic ultrasonography‐guided peripancreatic fluid collection drainage: A systematic review and network meta‐analysis

Park

Nam

et al. 2020

J of Gastro and Hepatol

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Background Although many studies have reported the efficacy of different stents for endoscopic ultrasonography (EUS)‐guided peripancreatic fluid collection (PFC) drainage, they have not completely determined which stent is superior. This network meta‐analysis comprehensively evaluated the comparative efficacy of stents used in EUS‐guided PFC. Methods We searched all relevant studies published up to February 2019 that examined the efficacy of double pigtail plastic stent (DPPS), fully covered self‐expanding metal stent (FCSEMS), and lumen‐apposing metal stent (LAMS) in EUS‐guided PFC drainage. We performed a Bayesian network meta‐analysis for clinical efficacy and adverse events. Results Fifteen studies comprising 1746 patients were included in the meta‐analysis. In terms of clinical success, no significant differences were noted in LAMS versus DPPS or LAMS versus FCSEMS (risk ratio [RR] 1.04 [95% credible interval (CrI) 0.99–1.11] and RR 0.96 [95% CrI 0.91–1.03]), respectively). FCSEMS was superior in terms of clinical success to DPPS (RR 1.09, 95% CrI 1.02–1.15). There was no significant difference in the recurrence of PFC among groups. Regarding adverse events, LAMS had a higher bleeding risk than FCSEMS (RR 6.70, 95% CrI 1.77–36.27) and tended to have a higher risk of bleeding than DPPS (RR 2.67, 95% CI 0.71–9.28). In terms of stent migration, there was no significant difference between any two groups compared. Conclusions FCSEMS had superior efficacy in terms of clinical success compared with DPPS stents. Significant superiority of LAMS to DPPS was not identified. Additionally, LAMS had the higher risk of bleeding than FCSEMS.

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“…Recently, LAMS designed for the drainage of pancreatic collections have appeared with demonstrated efficacy in a number of studies but they are also more costly [16][17][18][19][20]. These stents are totally covered and offer a maximum caliber of 15-20 mm, thereby allowing for endoscopic necrosectomy in repeated sessions without the need for replacement.…”

Section: Discussionmentioning

confidence: 99%

“…Although some international systematic endoscopic reviews and meta-analysis have recommended LAMS as the care standard for WON drainage, the quality of evidence is not high (retrospective, registry-based, or non-comparative) that LAMS are superior to PLASTIC stents in the management of WON by EUS-guided transmural drainage, and few studies have compared LAMS and plastic stents [15][16][17][18][19][20]. For all these reasons, a multicenter prospective, parallel group, randomized controlled clinical trial was designed to assess whether LAMS are superior to plastic stents in the endoscopic treatment of WON.…”

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confidence: 99%

Multicenter Study Of Plastic Vs. Self-expanding Metal Stents In Endoscopic Ultrasound-drainage Of Walled-off Pancreatic Necrosis – Prometheus: A Randomised Controlled Trial Protocol

Gornals

Pérez-Miranda

Vázquez-Sequeiros

et al. 2019

Preprint

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KEYWORDSEndoscopic ultrasound, lumen apposing metal stent, metal self-expanding stent, plastic stent, trial, walled-off necrosis 3 Abstract Background: It seems that the appearance of lumen-apposing metal stents (LAMS), are displacing the role of plastic stents in the therapy of pancreatic fluid collection as walled-off necrosis (WON). To date there is no quality of evidence to recommend LAMS as the standard treatment in management of WON. The theoretical benefit of LAMS over PLASTIC stents, need to be proved.Methods/design: This is a multicenter prospective study, superiority, randomized controlled clinical trial by parallel groups, without masking. One hundred fourteen patients with WON will be Endoscopic ultrasound (EUS)-guided transmural drained in 9 tertiary hospitals in Spain and will be randomized to the LAMS or PLASTIC stent group. The primary endpoint is to assess the short-term (4 weeks) clinical success determined by the reduction of the collection (to <50% or < 5cm in size), along with clinical improvement. Secondary endpoints: the long-term (4 months) clinical success (total resolution or 5cm); the procedure's duration, the level of difficulty, safety and recurrences.Discussion: The PROMETHEUS trial has been designed to response if LAMS are superior over PLASTIC stents in the EUS-guided transmural drainage of WON.

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A systematic review and meta-analysis of metal versus plastic stents for drainage of pancreatic fluid collections: metal stents are advantageous

Abstract: The use of metal stents for drainage of pancreatic fluid collections is associated with improved clinical success, fewer adverse events and reduced bleeding compared to plastic stents.

Cited by 54 publications

References 27 publications

Endoscopic Transmural Drainage is Associated With Improved Outcomes in Disconnected Pancreatic Duct Syndrome: A Systematic Review and Meta-analysis

Endoscopic Transmural Drainage is Associated With Improved Outcomes in Disconnected Pancreatic Duct Syndrome: A Systematic Review and Meta-analysis

Comparative efficacy of stents in endoscopic ultrasonography‐guided peripancreatic fluid collection drainage: A systematic review and network meta‐analysis

Multicenter Study Of Plastic Vs. Self-expanding Metal Stents In Endoscopic Ultrasound-drainage Of Walled-off Pancreatic Necrosis – Prometheus: A Randomised Controlled Trial Protocol

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