Efficacy and Safety of Lumen-Apposing Metal Stents in Management of Pancreatic Fluid Collections: Are They Better Than Plastic Stents? A Systematic Review and Meta-Analysis

Hammad, Tariq; Khan, Muhammad Ali; Alastal, Yaseen; Lee, Wade; Nawras, Ali; Ismail, Mohammad K.; Kahaleh, Michel

doi:10.1007/s10620-017-4851-0

Cited by 100 publications

(90 citation statements)

References 38 publications

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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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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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“…In a meta‐analysis of 11 studies with 688 patients, Hammand et al . found LAMS to be better than multiple plastic stents in terms of clinical success and adverse events . Another recent meta‐analysis performed by Bazerbachi et al .…”

Section: Use Of Self‐expanding Metal Stentsmentioning

confidence: 98%

“…32 In a meta-analysis of 11 studies with 688 patients, Hammand et al found LAMS to be better than multiple plastic stents in terms of clinical success and adverse events. 33 Another recent meta-analysis performed by Bazerbachi et al included 41 studies with 2213 patients with WOPN. 34 WOPN resolution was more likely with SEMS compared with plastic stents (P < 0.001).…”

Section: Use Of Self-expanding Metal Stentsmentioning

confidence: 99%

Endotherapy for pancreatic necrosis: An update

et al. 2018

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Approximately 20% of patients with acute pancreatitis develop pancreatic necrosis. The presence of necrosis in a pancreatic collection significantly worsens the prognosis. Pancreatic necrosis is associated with high mortality and morbidity. In the last few decades, there has been a significant revolution in the treatment of infected pancreatic necrosis. A step‐up approach has been proposed, from less invasive procedures to the operative intervention. Minimally invasive treatment modalities such as endoscopic drainage and necrosectomy, percutaneous drainage, and minimally invasive surgery have recently replaced open surgical necrosectomy as the first‐line treatment option. Endoscopic intervention for pancreatic necrosis is being increasingly performed with good success and a lower complication rate. However, techniques of endotherapy are still not uniform and vary as per local expertise, and there are still many unresolved questions with regard to the interventions in patients with pancreatic necrosis. The objective of this paper is to critically review the literature and update the concepts of endoscopic interventional therapy of pancreatic necrosis.

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“…Several systematic reviews and meta-analyses draw conflicting conclusions while comparing plastic stents vs. metal stents for ETD of PFCs [32][33][34][35][36][37]. In three of the published systematic reviews and meta-analyses, metal stents were found superior to plastic stents for both pseudocysts as well as WON in terms of clinical success and adverse events [34,36,32]. On the contrary, two other systematic reviews and meta-analyses did not find a difference in the outcomes between metal or plastic stents [33,37].…”

Section: Endoscopic Transmural Drainage: Choice Of Stentsmentioning

confidence: 99%

“…In addition, the treatment cost (LCMS: US$12155 vs. plastic stents: US$6609) and stent related adverse events were higher in the LCMS group (32.3 vs. 6.9%, p = 0.01) [24]. Several systematic reviews and meta-analyses draw conflicting conclusions while comparing plastic stents vs. metal stents for ETD of PFCs [32][33][34][35][36][37]. In three of the published systematic reviews and meta-analyses, metal stents were found superior to plastic stents for both pseudocysts as well as WON in terms of clinical success and adverse events [34,36,32].…”

Section: Endoscopic Transmural Drainage: Choice Of Stentsmentioning

confidence: 99%

Endoscopic Management of Pancreatic Fluid Collections: An Update

Nabi¹,

Reddy²

2019

Pancreatitis

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Pancreatic fluid collections (PFCs) are a frequent complication of acute pancreatitis. PFCs have been categorized according to their content and duration after an episode of pancreatitis. Acute collections (<4 week) and asymptomatic late collections (>4 weeks) can be usually managed conservatively. Late collections including walled off necrosis (WON) and pancreatic pseudocysts (PP) have a well-defined wall. Consequently, it is easier and safer to drain these collections when required. The most common indication to drain PFCs is infection and the available means of drainage include surgical, endoscopic, and percutaneous. Open surgical interventions carry a high risk of morbidity and mortality. Therefore, in the current era, a step up approach is preferred to minimize morbidity over the more aggressive surgical treatments. Endoscopic step-up approach is effective and favored over minimally invasive surgical or percutaneous drainage due to reduced risk of organ failure and external pancreatic fistula. However, the approach to PFCs should be individualized for optimal outcomes. A small subgroup of patients does not respond to endotherapy or percutaneous interventions and requires open surgical debridement. Similarly, not all PFCs are amenable to endoscopic drainage and demand alternative modalities like percutaneous or minimally invasive surgical drainage.

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Efficacy and Safety of Lumen-Apposing Metal Stents in Management of Pancreatic Fluid Collections: Are They Better Than Plastic Stents? A Systematic Review and Meta-Analysis

Abstract: LAMS seem to have excellent efficacy and safety in the management of PFCs. They may be preferred over plastic stents as they are associated with better clinical success and lesser adverse events.

Cited by 100 publications

References 38 publications

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

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

Endotherapy for pancreatic necrosis: An update

Endoscopic Management of Pancreatic Fluid Collections: An Update

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