Aims:
Pancreatic duct (PD) stent placement is an effective treatment for symptomatic chronic pancreatitis associated with PD stricture. A subset of patients is refractory then the placement of multiple plastic stents has demonstrated a higher clinical success rate. Self-expandable metal stents (SEMSs) have been used with unsatisfactory results because of migration. However, fully covered SEMSs (FC-SEMSs) have not been extensively studied in this clinical context.
Methods:
we searched multiple databases (Embase, PUBMED; Cochrane) to identify studies reporting the efficacy and safety of FC-SEMSs in patients with refractory symptomatic pancreatic strictures. Outcomes were technical success, stricture and pain resolution, recurrence of symptoms, adverse events and need for surgery. We reported proportions (expressed as a percentage), with their 95% CI, found in the individual studies included in the meta-analysis, given both for the Fixed effects model and the Random effects model. Pooled analysis was performed using a proportion with Medcalc statistical software.
Results:
9 studies were identified, for a total of 139 patients. FC-SEMS had a pooled rate (PR) of 98.5% for technical success, 85.3% (95% CI 69.3 – 96.1) for stricture resolution and 68.6% (95% CI 47.3 – 87.8) for complete pain resolution. Other outcomes were as follows: stricture recurrence (PR 15.4% 95% CI 6.1 – 27.9), need for re-stenting (PR 26.8% 95% CI 9.5 – 48.9), adverse event (PR 12.1% 95% CI 7.4 – 18.5), stent migration (PR 17.2% 95% CI 3.74 – 37.8), PEP (PR 12.7% 95% CI 5.7 – 23.3) severe pain (PR 18.7 95% CI 6.0 – 39.2), de novo stricture (PR 18.6% 95% CI 7.7 – 34.8), need for surgery (PR 10% 95% CI 1.8 – 28.3).
Conclusions:
FC-SEMSs are effective in the treatment of refractory strictures with a pooled rate of 85% for stricture resolution and 68% for pain resolution. However, FC-SEMSs carry a high rate of adverse events and stricture recurrence with the need for reintervention mostly related to stent migration. Further studies are needed to define the role of FC-SEMSs in refractory MPD strictures.
