Comparison of three different stents for endoscopic ultrasound‐guided drainage of pancreatic fluid collection: A large retrospective study

Abstract

Background and Aim Endoscopic transmural drainage has been recognized as the first‐line treatment for pancreatic fluid collection (PFC). Currently, three different types of stents have been extensively applied, including double pigtail plastic stent (PS), fully covered self‐expanding metal stent (FCSEMS), and novel lumen‐apposing metal stent (LAMS). Nonetheless, limited data are available about the comparison among them in terms of their clinical outcomes and safety for endoscopic ultrasound‐guided drainage of PFC. Methods The current retrospective study was carried on 160 PFC patients undergoing endoscopic ultrasound‐guided drainage from 2010 to 2018 at a single tertiary care center. Patients were divided into three groups based on different drainage ways: drainage using PS, FCSEMS, or LAMS. Results A total of 160 PFC patients (104 male and 56 female) were analyzed in this retrospective study, including 62 patients drained with PS, 28 with FCSEMS, and 70 with LAMS. Typically, the technical success (93.5% vs 96.4% vs 94.3%, P = 1.000) and treatment success rates (84.6% vs 85.2% vs 89.2%, P = 0.763) were similar between PS, FCSEMS, and LAMS. With regard to major adverse events, four patients (FCSEMS: n = 2 and LAMS: n = 2) with pseudoaneurysms developed severe bleeding; among them, 75% (3/4) of patients were observed within 2 weeks after intervention, and two patients in LAMS group died. Conclusions There are no significant differences in the clinical outcomes of PFC patients treated with PS, FCSEMS, or LAMS. Nonetheless, severe (or even fatal) bleeding may occur at the early stage after metal stent placement, which should be paid particular attention to.

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

“…Generally, the DPPS was considered to have a higher recurrence rate than metal stents for PFC drainage, because the diameter of the DPPS may not be sufficiently large; thus, more reinterventions might be required in EUS‐guided drainage through the DPPS than that through the metal stents . However, based on all data from relevant studies, the risk of recurrence was similar for the LAMS, FCSEMS, and DPPS.…”

“…The included studies had been published between 2014 and 2019, with an enrollment period that ranged from 2005 to 2017 (Table ) . Among them, two were designed as a three‐arm study that compared efficacy among LAMS, DPPS, and FCSEMS .…”

Are Lumen-Apposing Metal Stents More Effective Than Plastic Stents for the Management of Pancreatic Fluid Collections: An Updated Systematic Review and Meta-analysis

“…Our literature searches led to the identification of 1400 articles. After screening the titles and abstracts, 20 studies were found to meet our eligibility criteria ( Figure 1) [3,9,10,[12][13][14][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. A total of 1534 patients were included.…”

Endoscopic Transmural Necrosectomy: Timing, Indications, and Methods

“…Wang et al reported on the adverse events in three different types of stents: PSs, LAMSs, and fully covered self-expandable metallic stents. 20 They found no difference in the proportion of stent-related adverse events between stent types except LAMSs, which had the lowest risk of stent migration. 19 Stent occlusion and migration are manageable with endoscopy and rarely require surgery.…”

“…In contrast, bleeding from the development of a pseudoaneurysm is indicated for angiographic embolization, which was the main cause of mortality in that series. 20 Another report showed a low rate of self-limited bleeding in 5 out of 68 patients (7.3%) with WON after LAMS placement. 21 A recent meta-analysis with heterogeneous patients pooled from 11 studies (n=688) also confirmed the superiority of a LAMS over a PS in terms of lower rates of adverse events and re-intervention.…”