Metal versus plastic stents for drainage of pancreatic fluid collection: A meta‐analysis

Yoon, Seung Bae; Lee, In Seok; Choi, Myung-Gyu

doi:10.1177/2050640618761702

Cited by 42 publications

(46 citation statements)

References 38 publications

(123 reference statements)

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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 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%

“…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%

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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“…Another development in the stent evolution, lumen apposing metal stent (LAMS) development where this stent is used not only for endoscopic drainage procedure, but also for endoscopic necrosectomy procedure. This stent has also advantage in migration prevention when compared to FCMS [32][33][34][35].…”

Section: Endoscopic Management: Metal Vs Plastic Stentmentioning

confidence: 99%

Endoscopic Management of Pancreatic Fluid Collection in Acute Pancreatitis

Lesmana¹,

Lesmana²,

Ho³

2019

Pancreatitis

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Acute pancreatitis is an acute clinical condition where it can be manifested as mild disease or serious and life-threatening condition. There are several factors that may be responsible for this condition, such as genetic, gallstone disease, alcohol consumption, pancreatic trauma, medication, hypertriglyceridemia, autoimmune disease, and surgery. The most common manifestation of pancreatic parenchymal injury is pancreatic pseudocyst (PPC) formation, where peripancreatic fluid collection (PFCs) usually precedes this condition. Even though most of the pseudocyst can be managed conservatively, however in conditions such as infected pseudocyst or possible wall of necrosis (WON), there should be an early intervention management. Clinical evaluation and imaging studies have to be done in the beginning. Computed tomography (CT) scan or magnetic resonance imaging (MRI) are the main imaging techniques used to evaluate the characteristic of the cyst, the size, surrounding vascularity, and to assess the pancreatic duct itself with possible of fistula formation. Clinical conditions that are usually considered for early intervention management are symptomatic pseudocyst, large size of pseudocyst, presence of gastric outlet obstruction, or biliary obstruction. PFC should be evaluated as it has been classified based on type of pancreatitis, time frame, well-defined wall, and debris contained inside the cyst. Endoscopic management has replaced percutaneous and surgical approach in most of PFC cases. Nowadays, endoscopic ultrasound (EUS) has been widely used as the first-line tool for PFC drainage procedure. Pancreatic pseudocyst stenting is the most common procedure in most of the centers in the world. However, the cost, availability, and expertise are needed to be considered in clinical practice.

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Metal versus plastic stents for drainage of pancreatic fluid collection: A meta‐analysis

Abstract: Metal stents are superior to plastic stents for endoscopic transmural drainage of PFC because they have a higher clinical success rate and lower rate of adverse events.

Cited by 42 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

Endoscopic Management of Pancreatic Fluid Collections: An Update

Endoscopic Management of Pancreatic Fluid Collection in Acute Pancreatitis

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