DEN open · 2025
Endoscopic Ultrasound-guided Drainage With Lumen-apposing Metal Stent versus Plastic Stent for the Treatment of Pancreatic Pseudocyst: A Systematic Review and Meta-analysis.
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Ardengh André Orsini, Visconti Thiago Arantes de Carvalho, Dall'Agnol Marcelo Klotz, Fernandes Ygor Rocha, Veras Matheus de Oliveira, Valentim Dos Santos Evellin Souza, Lera do Santos Marcos Eduardo, Matuguma Sergio Eiji, Ardengh José Celso, Bernardo Wanderley Marques, Hourneaux de Moura Eduardo Guimarães
Аннотация
BACKGROUND: Pancreatic pseudocyst (PP), following acute or chronic pancreatitis, may become symptomatic or persist beyond 6-8 weeks, requiring drainage. Endoscopic ultrasonography-guided drainage (EUS-D) is the preferred method, using double pigtail plastic stents (DPPS) or self-expandable metallic stents (SEMS), such as lumen-apposing metal stents (LAMS). This meta-analysis compares DPPS and LAMS in EUS-D for PP, focusing on technical success, clinical success, adverse events (AEs), recurrence, and procedure time.
METHODS: A search strategy was conducted in MEDLINE, Embase, Lilacs, and Cochrane databases according to PRISMA guidelines. Random-effect models were used for statistical analysis based on intention-to-treat. Heterogeneity was assessed using the I2 test. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies-of Exposures tool. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation Tool.
RESULTS: Ten studies were included: one prospective cohort and nine retrospective cohorts, conducted between 2014 and 2024. A total of 502 patients with PP were treated with EUS-D. The clinical success rate was higher using LAMS (Risk ratio [RR] = 1.05; 95% confidence interval [CI]: 1.01; 1.09; I2 = 0%), with shorter procedure time (Mean difference = -16.30; 95% CI: -27.65; -4.94; I2 = 86%) compared to DPPS. No statistical difference was observed for early and late AEs, recurrence, or technical success.
CONCLUSION: The study demonstrated that LAMS has a higher clinical success rate and a shorter procedure time compared to DPPS. There is no difference in terms of early and late AEs, recurrence, and technical success.
METHODS: A search strategy was conducted in MEDLINE, Embase, Lilacs, and Cochrane databases according to PRISMA guidelines. Random-effect models were used for statistical analysis based on intention-to-treat. Heterogeneity was assessed using the I2 test. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies-of Exposures tool. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation Tool.
RESULTS: Ten studies were included: one prospective cohort and nine retrospective cohorts, conducted between 2014 and 2024. A total of 502 patients with PP were treated with EUS-D. The clinical success rate was higher using LAMS (Risk ratio [RR] = 1.05; 95% confidence interval [CI]: 1.01; 1.09; I2 = 0%), with shorter procedure time (Mean difference = -16.30; 95% CI: -27.65; -4.94; I2 = 86%) compared to DPPS. No statistical difference was observed for early and late AEs, recurrence, or technical success.
CONCLUSION: The study demonstrated that LAMS has a higher clinical success rate and a shorter procedure time compared to DPPS. There is no difference in terms of early and late AEs, recurrence, and technical success.