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

Vinay Chandrasekhara; Marc Barthet; Jacques Devière; Fateh Bazerbachi; Sundeep Lakhtakia; Jeffrey J. Easler; Joyce A. Peetermans; Edmund McMullen; Ornela Gjata; Margaret L. Gourlay; Barham K. Abu Dayyeh

doi:10.1055/a-1243-0092

Endoscopy International Open, Table of Contents

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

¹Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States

,

Marc Barthet

²Service d'hépato-gastroentérologie, Hôpital Nord, Chemin des Bourrely, Marseille, France

,

Jacques Devière

³Université Libre de Bruxelles, Brussels, Belgium

,

Fateh Bazerbachi

⁴Division of Gastroenterology, Interventional Endoscopy Program, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, United States

,

Sundeep Lakhtakia

⁵Gastroenterology and Therapeutic Endoscopy, Asian Institute of Gastroenterology, Hyderabad, India

,

Jeffrey J. Easler

⁶Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, United States

,

Joyce A. Peetermans

⁷Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, United States

,

Edmund McMullen

⁷Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, United States

,

Ornela Gjata

⁷Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, United States

,

Margaret L. Gourlay

⁷Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, United States

,

Barham K. Abu Dayyeh

¹Division 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.

Full Text

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Supplementary Material

Supplementary material