CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(11): E1639-E1653
DOI: 10.1055/a-1243-0092
Review

Safety and efficacy of lumen-apposing metal stents versus plastic stents to treat walled-off pancreatic necrosis: systematic review and meta-analysis

Vinay Chandrasekhara
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Marc Barthet
2  Service d'hépato-gastroentérologie, Hôpital Nord, Chemin des Bourrely, Marseille, France
,
Jacques Devière
3  Université Libre de Bruxelles, Brussels, Belgium
,
Fateh Bazerbachi
4  Division of Gastroenterology, Interventional Endoscopy Program, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, United States
,
Sundeep Lakhtakia
5  Gastroenterology and Therapeutic Endoscopy, Asian Institute of Gastroenterology, Hyderabad, India
,
Jeffrey J. Easler
6  Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, United States
,
Joyce A. Peetermans
7  Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, United States
,
Edmund McMullen
7  Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, United States
,
Ornela Gjata
7  Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, United States
,
Margaret L. Gourlay
7  Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, United States
,
Barham K. Abu Dayyeh
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
› Author Affiliations
  

Abstract

Background and study aims Lumen-apposing metal stents (LAMS) are increasingly used for drainage of walled-off pancreatic necrosis (WON). Recent studies suggested greater adverse event (AE) rates with LAMS for WON. We conducted a systematic review and meta-analysis to compare the safety and efficacy of LAMS with double-pigtail plastic stents (DPPS) for endoscopic drainage of WON. The primary aim was to evaluate stent-related AEs.

Methods In October 2019, we searched the Ovid (Embase, MEDLINE, Cochrane) and Scopus databases for studies assessing a specific LAMS or DPPS for WON drainage conducted under EUS guidance. Safety outcomes were AE rates of bleeding, stent migration, perforation, and stent occlusion. Efficacy outcomes were WON resolution and number of procedures needed to achieve resolution. A subanalysis including non-EUS-guided cases was performed.

Results Thirty studies including one randomized controlled trial (total 1,524 patients) were analyzed. LAMS were associated with similar bleeding (2.5 % vs. 4.6 %, P = 0.39) and perforation risk (0.5 % vs. 1.1 %, P = 0.35) compared to DPPS. WON resolution (87.4 % vs. 87.5 %, P = 0.99), number of procedures to achieve resolution (2.09 vs. 1.88, P = 0.72), stent migration (5.9 % vs. 6.8 %, P = 0.79), and stent occlusion (3.8 % vs. 5.2 %, P = 0.78) were similar for both groups. Inclusion of non-EUS-guided cases led to significantly higher DPPS bleeding and perforation rates.

Conclusions LAMS and DPPS were associated with similar rates of AEs and WON resolution when limiting analysis to EUS-guided cases. Higher bleeding rates were seen in historical studies of DPPS without EUS guidance. Additional high-quality studies of WON treatment using consistent outcome definitions are needed.

Supplementary material



Publication History

Received: 19 May 2020

Accepted: 20 July 2020

Publication Date:
22 October 2020 (online)

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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