Risk of recurrence with or without plastic stent after EUS-guided treatment of peripancreatic fluid collections: A systematic review and meta-analysis

Takuji Iwashita; Tatsuya Sato; Tsuyoshi Hamada; Tomotaka Saito; Keisuke Iwata; Hideyuki Shiomi; Mamoru Takenaka; Akinori Maruta; Shinya Uemura; Atsuhiro Masuda; Saburo Matsubara; Tsuyoshi Mukai; Hiroyuki Isayama; Ichiro Yasuda; Yousuke Nakai

doi:10.1055/a-2226-1237

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(02): E188-E198
DOI: 10.1055/a-2226-1237

Review

Risk of recurrence with or without plastic stent after EUS-guided treatment of peripancreatic fluid collections: A systematic review and meta-analysis

Authors

Takuji Iwashita ‡

¹First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan (Ringgold ID: RIN476117)
Tatsuya Sato ‡

²Department of Gastroenterology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
Tsuyoshi Hamada

²Department of Gastroenterology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan

³Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Tomotaka Saito

²Department of Gastroenterology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
Keisuke Iwata

⁴Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan (Ringgold ID: RIN38226)
Hideyuki Shiomi

⁵Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan (Ringgold ID: RIN12818)
Mamoru Takenaka

⁶Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
Akinori Maruta

⁷Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan (Ringgold ID: RIN68266)
Shinya Uemura

¹First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan (Ringgold ID: RIN476117)
Atsuhiro Masuda

⁸Department of Gastroenterology, Kobe University Graduate School of Medicine, Hyogo, Japan
Saburo Matsubara

⁹Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
Tsuyoshi Mukai

¹⁰Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan (Ringgold ID: RIN12857)
Hiroyuki Isayama

¹¹Department of Gastroenterology, Juntendo University Graduate School of Medicine, Tokyo, Japan
Ichiro Yasuda‡

¹²Third Department of Internal Medicine, University of Toyama, Toyama, Japan
Yousuke Nakai ‡

²Department of Gastroenterology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan

¹³Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan (Ringgold ID: RIN26782)

Abstract

Background and study aims Recent advances in endoscopic transmural treatment have improved the clinical outcomes of patients with pancreatic fluid collections (PFCs). However, there is still a debate about the preventive effect of long-term placement of a transmural plastic stent (PS) on recurrence after successful endoscopic ultrasound (EUS)-guided treatment of PFCs. We conducted a systematic review and meta-analysis to evaluate PFC recurrence rates with and without a transmural PS after EUS-guided treatment.

Patients and methods A systematic literature search of PubMed, Embase, and the Cochrane database was conducted to identify clinical studies comparing outcomes with and without transmural PS published until September 2022. Data on PFC recurrence and adverse events (AEs) were pooled using a random-effects model.

Results Nine studies including 380 patients with long-term transmural PS and 289 patients without PS were identified. The rate of PFC recurrence was significantly lower in patients with transmural PS (pooled odds ratio [OR] = 0.23, 95% confidence interval [CI] [0.08-0.65], P = 0.005). In a subgroup analysis limited to studies focusing on patients with disconnected pancreatic duct syndrome, which has been reported to be a risk factor for PFC recurrence, the OR was numerically lower than that for the entire cohort (OR = 0.14, 95% CI [0.04-0.46]). The rate of AEs was significantly higher with long-term transmural PS (OR = 14.77, 95% CI [4.21-51.83]).

Conclusions In this meta-analysis, long-term PS placement reduced the risk of PFC recurrence. Given the potential AEs of indwelling PS, further research is required to evaluate the overall benefits of long-term PS placement.

Keywords

Intervention EUS - Pancreas - Endoscopic ultrasonography - Biliary tract

Full Text

References

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