Lumen-Apposing Metal Stent With and Without Concurrent Double-Pigtail Plastic Stent for Pancreatic Fluid Collections: A Comparative Systematic Review and Meta-Analysis

Azizullah Beran, Mouhand F H Mohamed, Thaer Abdelfattah, Yara Sarkis, Jonathan Montrose, Wasef Sayeh, Rami Musallam, Fouad Jaber, Khaled Elfert, Eleazar Montalvan-Sanchez, Mohammad Al-Haddad, Azizullah Beran, Mouhand F H Mohamed, Thaer Abdelfattah, Yara Sarkis, Jonathan Montrose, Wasef Sayeh, Rami Musallam, Fouad Jaber, Khaled Elfert, Eleazar Montalvan-Sanchez, Mohammad Al-Haddad

Abstract

Background: Lumen-apposing metal stents (LAMSs) are often used to drain pancreatic fluid collections (PFCs). However, adverse events, such as stent obstruction, infection, or bleeding, have been reported. Concurrent double-pigtail plastic stent (DPPS) deployment has been suggested to prevent these adverse events. This meta-analysis aimed to compare the clinical outcomes of LAMS with DPPS vs. LAMS alone in the drainage of PFCs.

Methods: An extensive search was conducted in the literature to include all the eligible studies that compared LAMS with DPPS vs. LAMS alone for drainage of PFCs. Pooled risk ratios (RRs) with the 95% confidence intervals (CIs) were obtained within a random-effect model. The outcomes were technical and clinical success, and overall adverse events, including stent migration and occlusion, bleeding, infection, and perforation.

Results: Five studies involving 281 patients with PFCs (137 received LAMS plus DPPS vs. 144 received LAMS alone) were included. LAMS plus DPPS group was associated with comparable technical success (RR: 1.01, 95% CI: 0.97 - 1.04, P = 0.70) and clinical success (RR: 1.01, 95% CI: 0.88 - 1.17). Lower trends of overall adverse events (RR: 0.64, 95% CI: 0.32 - 1.29), stent occlusion (RR: 0.63, 95% CI: 0.27 - 1.49), infection (RR: 0.50, 95% CI: 0.15 - 1.64), and perforation (RR: 0.42, 95% CI: 0.06 - 2.78) were observed in LAMS with DPPS group compared to LAMS alone but without a statistical significance. Stent migration (RR: 1.29, 95% CI: 0.50 - 3.34) and bleeding (RR: 0.65, 95% CI: 0.25 - 1.72) were similar between the two groups.

Conclusions: Deployment of DPPS across LAMS for drainage of PFCs has no significant impact on efficacy or safety outcomes. Randomized, controlled trials are necessary to confirm our study results, especially in walled-off pancreatic necrosis.

Keywords: Double-pigtail plastic stent; Lumen-apposing metal stent; Pancreatic fluid collection; Walled-off pancreatic necrosis.

Conflict of interest statement

The authors do not have any conflict of interest to declare.

Copyright 2023, Beran et al.

Figures

Figure 1
Figure 1
PRISMA flow diagram of included studies. PRISMA: preferred reporting items for systematic reviews and meta-analyses; DPPS: double-pigtail plastic stent; LAMS: lumen-apposing metal stent.
Figure 2
Figure 2
Forest plots comparing between LAMS plus DPPS and LAMS alone for drainage of pancreatic fluid collections regarding: (a) technical success and (b) clinical success. DPPS: double-pigtail plastic stent; LAMS: lumen-apposing metal stent; CI: confidence interval.
Figure 3
Figure 3
Forest plots comparing between LAMS plus DPPS and LAMS alone for drainage of pancreatic fluid collections regarding: (a) overall adverse events, (b) stent migration, and (c) stent occlusion. DPPS: double-pigtail plastic stent; LAMS: lumen-apposing metal stent; CI: confidence interval.
Figure 4
Figure 4
Forest plots comparing between LAMS plus DPPS and LAMS alone for drainage of pancreatic fluid collections regarding: (a) bleeding, (b) infection, and (c) perforation. DPPS: double-pigtail plastic stent; LAMS: lumen-apposing metal stent; CI: confidence interval.

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Source: PubMed

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