Comparative outcomes of endoscopic ultrasound‐guided lumen‐apposing mental stents drainage for pancreatic pseudocysts and walled‐off necrosis: Case series and meta‐analysis

Abstract

Background Endoscopic ultrasound (EUS)-guided transmural drainage for pancreatic fluid collections (PFCs) has become the first-line treatment with quicker recovery and more minor injury compared with surgery and percutaneous drainage. The efficacy of stents implantation and drainage for different PFCs remains controversial, especially lumen-apposing metal stents (LAMS). This study aimed to compare the efficacy and safety of LAMS drainage for pancreatic pseudocysts (PPC) and walled-off necrosis (WON). Methods A meta-analysis was performed for LAMS drainage for WON and PPC by systematically searching PubMed, Cochrane, and Embase databases from January 2010 to January 2020. From 2017 to 2019, 12 patients who were treated with LAMS drainage for PFCs in our medical center were also reviewed and included in this study. Results Combining 11 copies of documents with the data from our medical center, a total of 585 patients with PFCs were enrolled in this meta-analysis, including 343 patients with WON and 242 with PPC. The technical success rate in WON is not significantly different from that of PPC ( P = 0.08 > 0.05). The clinical success of LAMS placement was achieved in 99% vs 89% in PPC and WON, respectively (RR = 0.92, 95% CI: 0.86–0.98, P = 0.01 < 0.05). The further intervention of direct endoscopic necrosectomy was required by 60% of patients in WON group. There was no significant difference in the incidence of adverse events, including infection, bleeding, stent migration and stent occlusion, after LAMS placement between WON and PPC. Conclusions Endoscopic ultrasound-guided LAMS for PFCs are feasible, effective with preferable technical and clinical success rates. The clinical effect of LAMS on PPC is slightly better than that of WON, but its adverse reactions still need to be verified in a large-sample prospective study.

Safety and efficacy of lumen-apposing metal stents and double-pigtail plastic stents for endoscopic ultrasound-guided drainage of walled-off necrosis; a systematic review and meta-analysis

“…Another case series and meta-analysis by Li et al. [ 40 ] also reported that for PFC, LAMS showed preferable clinical success and AEs. A meta-analysis of eleven studies comparing the data of 688 patients with PFC through the LAMS and the DPS indicated that the LAMS showed better efficacy in managing PFC [ 41 ].…”

Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence

“…Xu et al [ 91 ] reported that EUS outperformed CT in accurately categorizing symptomatic peripancreatic fluid collections and emerged as a preferred imaging modality for detecting solid necrotic debris. EUS-guided lumen-apposing metal stents for pancreatic fluid collections were feasible and effective with preferable technical and clinical success rates[ 92 ].…”

Microbial Spectra and Clinical Outcomes from Endoscopically Drained Pancreatic Fluid Collections: A Descriptive Cohort Study

“…By contrast, LAMS are characterized by large-bore caliber sizes with extended patency and offer unimpeded access to the cavity for direct necrosectomies. However, stent migration and bleeding have been described as relevant adverse events [10,11].…”