Head‐to‐head comparison between endoscopic ultrasound guided lumen apposing metal stent and plastic stents for the treatment of pancreatic fluid collections: A systematic review and meta‐analysis

Abstract

Background/Aims Peripancreatic fluid collections (PFCs) result from acute or chronic pancreatic inflammation that suffers a rupture of its ducts. Currently, there exists three options for drainage or debridement of pancreatic pseudocysts and walled‐off necrosis (WON). The traditional procedure is drainage by placing double pigtail plastic stents (DPPS); lumen‐apposing metal stent (LAMS) has a biflanged design with a wide lumen that avoids occlusion with necrotic tissue, which is more common with DPPS and reduces the possibility of migration. We performed a systematic review and meta‐analyses head‐to‐head, including only studies that compare the two main techniques to drainage of PFCs: LAMS vs DPPS. Methods We conducted a systematic review in different databases, such as PubMed, OVID, Medline, and Cochrane Databases. This meta‐analysis considers studies published from 2014 to 2020, including only studies that compare the two main techniques to drainage of PFCs: LAMS vs DPPS. Results Thirteen studies were included in the meta‐analyses. Only one of all studies was a randomized controlled trial. These studies comprise 1584 patients; 68.2% were male, and 31.8% were female. Six hundred sixty‐three patients (41.9%) were treated with LAMS, and 921 (58.1%) were treated with DPPS. Six studies included only WON in their analysis, two included only pancreatic pseudocysts, and five studies included both pancreatic pseudocysts and WON. The technical success was similar in patients treated with LAMS and DPPS (97.6% vs 97.5%, respectively, P = .986, RR = 1.00 [95% CI 0.93‐1.08]). The clinical success was similar in both groups (LAMS: 90.1% vs DPPS: 84.2%, P = .139, RR = 1.063 [95% CI 0.98‐1.15]). Patients treated with LAMS had a lower complication rate than the DPPS groups, with a significant statistical difference (LAMS: 16.0% vs DPPS: 20.2%, P = .009, RR = 0.746 [95% CI 0.60‐0.93]). Bleeding was the most common complication in the LAMS group (33 patients, [5.0%]), whereas infection was the most common complication in the DPPS group (56 patients, [6.1%]). The LAMS migration rate was lower than in the DPPS (0.9% vs 2.2%, respectively, P = .05). The mortality rate was similar in both groups, 0.6% in the LAMS group (four patients) and 0.4% in the DPPS group (four patients; P = .640). Conclusion The PFCs drainage is an indication when persistent symptoms or PFCs‐related complications exist. EUS guided drainage with LAMS has similar technical and clinical success to DPPS drainage for the management of PFCs. The technical and clinical success rates are high in both groups. However, LAMS drainage has a lower adverse events rate than DPPS drainage. More randomized controlled trials are needed to confirm the real advantage of LAMS drainage over DPPS drainage.

Comparison of lumen-apposing metal stents versus double-pigtail plastic stents for infected necrotising pancreatitis

“…A longer period is usually not required, because exchange for plastic stents is possible when the necrotic collection is not fully resolved. In conclusion, we confirm the results of a recent systematic review of mainly retrospective studies, reporting that there is no increased bleeding risk when using LAMS 22. The results of two ongoing randomised trials will provide more information on LAMS safety 23 24…”

The Role of EUS-Guided Drainage in the Management of Postoperative Fluid Collections after Pancreatobiliary Surgery

“…Data from a randomised controlled trial did not show a significant difference in the overall clinical outcome and adverse events when compared to placing multiple plastic stents for pancreatic walled-off necrosis [29]. However, two meta-analyses published in 2021 seemed to suggest that LAMSs may be superior to plastic stents in terms of clinical success, recurrence of pancreatic fluid collection, need of additional intervention, and adverse events [30,31].…”

Endotherapy in Pancreatic Diseases

“…24,25 EUS guided drainage with LAMS is preferred for drainage of larger PFC as well as collections with significant solid debris because their larger luminal diameter facilitates prompt drainage and longer patency of the stent. 26 However, their use in pseudocysts does not appear to be advantageous over plastic stents probably given the absence of solid debris resulting in effective drainage via plastic stents also. Therefore plastic stents may be preferred over LAMS in the management of patients with pancreatic pseudocysts as their use seems to be cost-effective.…”