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

Abstract

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.

Comparison Between Lumen-Apposing Metal Stents and Plastic Stents in Endoscopic Ultrasound–Guided Drainage of Pancreatic Fluid Collection

“…10 Some previous studies showed that LAMS may be associated with a higher rate of adverse events. 11,12 Although several systematic studies have compared the safety and efficacy between LAMS and DPPS, there remains a lack of high-quality evidence, and the sample sizes in previous studies were small. In addition, several recent studies have been published.…”

Use of double biopsy forceps: A novel technique for safe removal of migrating stent after EUS‐guided pancreatic drainage

“…Stent migration is an adverse effect of EUS‐guided pancreatic drainage and other EUS interventions 2 . Removal of the migrating stent carries risk of bleeding due to scratching injury of the fistula.…”

“…It sometimes results in walled‐off necrotic fluid collection 1 . Endoscopic ultrasound‐guided drainage of necrotic fluid collection has become the first line treatment deploying either lumen‐apposing metallic stent (LAMS) or double‐pigtail plastic stent (DPPS) 2 . One of the adverse effects of such procedure is stent migration.…”

Current status of treatments of pancreatic and peripancreatic collections of acute pancreatitis

“…Even though some studies show LAMS might have a slight advantage over plastic stents in terms of clinical success[ 27 , 59 , 60 ], more studies have shown that there were no differences between LAMS and plastic stents regarding the technical success rate, clinical success, recurrence in drainage of pancreatic, and peripancreatic collections[ 24 , 25 , 60 - 62 ]. In contrast, the bleeding risk (including pseudoaneurysm bleeding, which is life-threatening and may require immediate interventional radiology-guided coil embolization or open surgery) is higher in the LAMS group[ 32 , 61 , 62 ]. Moreover, in an RCT, non-superiority of LAMS over plastic stents was observed, and stent-related adverse events and procedure costs of LAMS were higher[ 63 ].…”