Direct comparison of efficacy and safety of metallic stents versus plastic stents for endoscopic drainage of pancreatic pseudocysts: a systematic review and meta-analysis.

BACKGROUND

Pancreatic pseudocyst (PPC) is a type of pancreatic fluid collection (PFCs), and endoscopic ultrasound-guided drainage is a common treatment. This study analyzed the efficacy and safety of plastic and metallic stents in managing PPC to provide evidence for clinical practice.

METHODS

PubMed, EMBASE, and Cochrane Library were searched for observational studies (Jan 1, 2014-Mar 1, 2025) on metallic/plastic stent treatment for PPC. Primary outcomes were technical and clinical success; recurrence and adverse events (AEs) were secondary. Data were synthesized using fixed-effect models.

RESULTS

Ten studies were included. Pooled analysis showed metallic stents had higher clinical success (RR = 1.07, 95 % CI 1.03-1.11, p = 0.001) and lower recurrence (RR = 0.41, 95 % CI 0.20-0.85, p = 0.02) than plastic stents. Technical success did not differ significantly (RR = 1.01, 95 % CI 0.99-1.04, p = 0.35). Metallic stents also had fewer total AEs (RR = 0.51, 95 % CI 0.36-0.73, p = 0.0003) and infections (RR = 0.33, 95 % CI 0.16-0.68, p = 0.003).

CONCLUSION

Metallic stents improve clinical success, reduce AEs and infection risk versus plastic stents. Robust prospective studies with long-term follow-up are needed for validation.