Efficacy of metal and plastic stents for transmural drainage of pancreatic fluid collections: a systematic review.
Metal stents are being used more frequently for transmural endoscopic drainage of pancreatic fluid collections (PFC) despite lack of data. The present systematic review was conducted to compare the rates of treatment success, adverse events and recurrence between patients undergoing metal versus plastic stent placement for endoscopic transmural drainage of PFC.
MEDLINE and EMBASE were searched to identify all published manuscripts that evaluated metal stents for endoscopic transmural drainage of PFC. All published studies from the same period involving plastic stent placement for PFC drainage that included >50 patients were also identified. Main outcome measures were to compare the rates of treatment success, adverse events and recurrence between the metal and plastic stent cohorts.
Seventeen studies (881 patients) met inclusion criteria. There was no difference in overall treatment success between patients treated with plastic and metal stents (81% [95% CI, 77-84%] vs 82% [95% CI, 74-88%]) for both pseudocysts (85% [95% CI, 81-89%] vs 83% [95% CI, 74-89%]) and walled-off necrosis (70% [95% CI, 62-76%] vs 78% [95% CI, 50-93%]). Also, there was no difference in the rates of adverse events (16% [95% CI, 14-39%] vs 23% [95% CI, 16-33%]) or recurrence (10% [95% CI, 8-13%] vs 9% [95% CI, 4-19%]) between plastic and metal stents.
Current evidence does not support routine placement of metal stents for transmural drainage of PFC. Randomized trials are needed to justify the use of metal stents for PFC drainage.
Bang JY
，Hawes R
，Bartolucci A
，Varadarajulu S
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New fully covered large-bore wide-flare removable metal stent for drainage of pancreatic fluid collections: results of a multicenter study.
Endoscopic transmural drainage (ETMD) of peripancreatic fluid collections (PFC) is an effective alternative to surgical drainage. Conventional drainage using plastic stents has its limitations. A wide-bore short-length wide flange fully covered self-expandable metallic stent (FCSEMS) has recently been developed. The present study evaluates the efficacy of this new FCSEMS for ETMD of PFC.
This was a retrospective, multicenter study. Patients with PFC undergoing endoscopic ultrasound (EUS)-guided drainage of PFC using specially designed FCSEMS were included. Parameters evaluated were technical success of stent placement, clinical success as defined by resolution of PFC without any further surgical intervention, ability to carry out endoscopic necrosectomy, complications and feasibility of endoscopic stent removal.
Twenty-one PFC in 19 patients were drained using FCSEMS. Technical and clinical success for drainage was seen in all patients (100%). Endoscopic necrosectomy was carried out in seven (33%) PFC. Complications occurred in two patients (10.5%). Stents could be endoscopically removed in all patients (100%).
The new specially designed FCSEMS is safe and effective for drainage of PFC. Necrosectomy can be carried out through the stent. Stent can be removed endoscopically at the end of the treatment period.
Bapaye A
，Itoi T
，Kongkam P
，Dubale N
，Mukai S
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Fully covered self-expanding metal stents versus lumen-apposing fully covered self-expanding metal stent versus plastic stents for endoscopic drainage of pancreatic walled-off necrosis: clinical outcomes and success.
Endoscopic transmural drainage/debridement of pancreatic walled-off necrosis (WON) has been performed using double-pigtail plastic (DP), fully covered self-expanding metal stents (FCSEMSs), or the novel lumen-apposing fully covered self-expanding metal stent (LAMS). Our aim was to perform a retrospective cohort study to compare the clinical outcomes and adverse events of EUS-guided drainage/debridement of WON with DP stents, FCSEMSs, and LAMSs.
Consecutive patients in 2 centers with WON managed by EUS-guided debridement were divided into 3 groups: (1) those who underwent debridement using DP stents, (2) debridement using FCSEMSs, (3) debridement using LAMSs. Technical success (ability to access and drain a WON by placement of transmural stents), early adverse events, number of procedures performed per patient to achieve WON resolution, and long-term success (complete resolution of the WON without need for further reintervention at 6 months after treatment) were evaluated.
From 2010 to 2015, 313 patients (23.3% female; mean age, 53 years) underwent WON debridement, including 106 who were drained using DP stents, 121 using FCSEMSs, and 86 using LAMSs. The 3 groups were matched for age, cause of the pancreatitis, WON size, and location. The cause of the patients' pancreatitis was gallstones (40.6%), alcohol (30.7%), idiopathic (13.1%), and other causes (15.6%). The mean cyst size was 102 mm (range, 20-510 mm). The mean number of endoscopy sessions was 2.5 (range, 1-13). The technical success rate of stent placement was 99%. Early adverse events were noted in 27 of 313 (8.6%) patients (perforation in 6, bleeding in 8, suprainfection in 9, other in 7). Successful endoscopic therapy was noted in 277 of 313 (89.6%) patients. When comparing the 3 groups, there was no difference in the technical success (P = .37). Early adverse events were significantly lower in the FCSEMS group compared with the DP and LAMS groups (1.6%, 7.5%, and 9.3%; P < .01). At 6-month follow-up, the rate of complete resolution of WON was lower with DP stents compared with FCSEMSs and LAMSs (81% vs 95% vs 90%; P = .001). The mean number of procedures required for WON resolution was significantly lower in the LAMS group compared with the FCSEMS and DP groups (2.2 vs 3 vs 3.6, respectively; P = .04). On multivariable analysis, DP stents remain the sole negative predictor for successful resolution of WON (odds ratio [OR], 0.18; 95% confidence interval, 0.06-0.53; P = .002) after adjusting for age, sex, and WON size. Although there was no significant difference between FCSEMSs and LAMSs for WON resolution, the LAMS was more likely to have early adverse events (OR, 6.6; P = .02).
EUS-guided drainage/debridement of WON using FCSEMSs and LAMSs is superior to DP stents in terms of overall treatment efficacy. The number of procedures required for WON resolution was significantly lower with LAMSs compared with FCSEMSs and DP stents.
Siddiqui AA
，Kowalski TE
，Loren DE
，Khalid A
，Soomro A
，Mazhar SM
，Isby L
，Kahaleh M
，Karia K
，Yoo J
，Ofosu A
，Ng B
，Sharaiha RZ
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