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

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)

› Author Affiliations

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

References
1 Banks PA, Bollen TL, Dervenis C. et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111
2 Varadarajulu S, Lopes TL, Wilcox CM. et al. EUS versus surgical cyst-gastrostomy for management of pancreatic pseudocysts. Gastrointest Endosc 2008; 68: 649-655
3 Varadarajulu S, Bang JY, Sutton BS. et al. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology 2013; 145: 583-590 e581
4 Teoh AYB, Dhir V, Kida M. et al. Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel. Gut 2018; 67: 1209-1228
5 Seifert H, Wehrmann T, Schmitt T. et al. Retroperitoneal endoscopic debridement for infected peripancreatic necrosis. Lancet 2000; 356: 653-655
6 Seifert H, Biermer M, Schmitt W. et al. Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study). Gut 2009; 58: 1260-1266
7 Gardner TB, Coelho-Prabhu N, Gordon SR. et al. Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U.S. series. Gastrointest Endosc 2011; 73: 718-726
8 Yasuda I, Nakashima M, Iwai T. et al. Japanese multicenter experience of endoscopic necrosectomy for infected walled-off pancreatic necrosis: The JENIPaN study. Endoscopy 2013; 45: 627-634
9 Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13: e1-15
10 van Brunschot S, van Grinsven J, van Santvoort HC. et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet 2018; 391: 51-58
11 Mukai S, Itoi T, Baron TH. et al. Endoscopic ultrasound-guided placement of plastic vs. biflanged metal stents for therapy of walled-off necrosis: a retrospective single-center series. Endoscopy 2015; 47: 47-55
12 Bapaye A, Dubale NA, Sheth KA. et al. Endoscopic ultrasonography-guided transmural drainage of walled-off pancreatic necrosis: Comparison between a specially designed fully covered bi-flanged metal stent and multiple plastic stents. Dig Endosc 2017; 29: 104-110
13 Siddiqui AA, Kowalski TE, Loren DE. et al. 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. Gastrointest Endosc 2017; 85: 758-765
14 Bang JY, Wilcox CM, Navaneethan U. et al. Impact of endoprosthesis type on inflammatory response in patients undergoing endoscopic drainage of pancreatic fluid collections. Dig Endosc 2023;
15 Hamada T, Iwashita T, Saito T. et al. Disconnected pancreatic duct syndrome and outcomes of endoscopic ultrasound-guided treatment of pancreatic fluid collections: Systematic review and meta-analysis. Dig Endosc 2022; 34: 676-686
16 Iwashita T, Iwata K, Hamada T. et al. Supportive treatment during the periprocedural period of endoscopic treatment for pancreatic fluid collections: a critical review of current knowledge and future perspectives. J Gastroenterol 2023; 58: 98-111
17 Nakai Y, Shiomi H, Hamada T. et al. Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta-analysis. DEN Open 2023; 3: e171
18 Facciorusso A, Amato A, Crino SF. et al. Nomogram for prediction of adverse events after lumen-apposing metal stent placement for drainage of pancreatic fluid collections. Dig Endosc 2022; 34: 1459-1470
19 Onnekink AM, Boxhoorn L, Timmerhuis HC. et al. Endoscopic versus surgical step-up approach for infected necrotizing pancreatitis (ExTENSION): long-term follow-up of a randomized trial. Gastroenterology 2022;
20 Bartholdy A, Werge M, Novovic S. et al. Endoscopic treatment with transmural drainage and necrosectomy for walled-off necrosis provides favourable long-term outcomes on pancreatic function. United European Gastroenterol J 2020; 8: 552-558
21 Verma S, Rana SS. Disconnected pancreatic duct syndrome: Updated review on clinical implications and management. Pancreatology 2020; 20: 1035-1044
22 Pawa R, Dorrell R, Russell G. et al. Long-term transmural drainage of pancreatic fluid collections with double pigtail stents following lumen-apposing metal stent placement improves recurrence-free survival in disconnected pancreatic duct syndrome. Dig Endosc 2022; 34: 1234-1241
23 Chavan R, Nabi Z, Lakhtakia S. et al. Impact of transmural plastic stent on recurrence of pancreatic fluid collection after metal stent removal in disconnected pancreatic duct: a randomized controlled trial. Endoscopy 2022; 54: 861-868
24 Wells GA, Shea B, O'Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
25 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
26 Arvanitakis M, Delhaye M, Bali MA. et al. Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest Endosc 2007; 65: 609-619
27 Kato S, Katanuma A, Maguchi H. et al. Efficacy, safety, and long-term follow-up results of eus-guided transmural drainage for pancreatic pseudocyst. Diagn Ther Endosc 2013; 2013: 924291
28 Bang JY, Wilcox CM, Trevino J. et al. Factors impacting treatment outcomes in the endoscopic management of walled-off pancreatic necrosis. J Gastroenterol Hepatol 2013; 28: 1725-1732
29 Ruckert F, Lietzmann A, Wilhelm TJ. et al. Long-term results after endoscopic drainage of pancreatic pseudocysts: A single-center experience. Pancreatology 2017; 17: 555-560
30 Bang JY, Wilcox CM, Navaneethan U. et al. Impact of disconnected pancreatic duct syndrome on the endoscopic management of pancreatic fluid collections. Ann Surg 2018; 267: 561-568
31 Bang JY, Mel Wilcox C, Arnoletti JP. et al. Importance of disconnected pancreatic duct syndrome in recurrence of pancreatic fluid collections initially drained using lumen-apposing metal stents. Clin Gastroenterol Hepatol 2021; 19: 1275-1281 e1272
32 Wang L, Elhanafi S, Storm AC. et al. Impact of disconnected pancreatic duct syndrome on endoscopic ultrasound-guided drainage of pancreatic fluid collections. Endoscopy 2021; 53: 603-610
33 Ni J, Peng K, Yu L. et al. Transpapillary stenting improves treatment outcomes in patients undergoing endoscopic transmural drainage of ductal disruption-associated pancreatic fluid collections. Am J Gastroenterol 2022;
34 Karjula H, Nordblad Schmidt P, Makela J. et al. Prophylactic pancreatic duct stenting in severe acute necrotizing pancreatitis: a prospective randomized study. Endoscopy 2019; 51: 1027-1034
35 Bang JY, Hasan M, Navaneethan U. et al. Lumen-apposing metal stents (LAMS) for pancreatic fluid collection (PFC) drainage: may not be business as usual. Gut 2017; 66: 2054-2056
36 Brimhall B, Han S, Tatman PD. et al. Increased incidence of pseudoaneurysm bleeding with lumen-apposing metal stents compared to double-pigtail plastic stents in patients with peripancreatic fluid collections. Clin Gastroenterol Hepatol 2018; 16: 1521-1528
37 Bang JY, Hawes RH, Varadarajulu S. Lumen-apposing metal stent placement for drainage of pancreatic fluid collections: predictors of adverse events. Gut 2020; 69: 1379-1381
38 Yamauchi H, Iwai T, Kida M. et al. Complications of long-term indwelling transmural double pigtail stent placement for symptomatic peripancreatic fluid collections. Dig Dis Sci 2019; 64: 1976-1984
39 Gkolfakis P, Bourguignon A, Arvanitakis M. et al. Indwelling double-pigtail plastic stents for treating disconnected pancreatic duct syndrome-associated peripancreatic fluid collections: long-term safety and efficacy. Endoscopy 2021; 53: 1141-1149