A systematic review and meta-analysis of metal versus plastic stents for drainage of pancreatic fluid collections: metal stents are advantageous



Saunders, Rebecca, Ramesh, Jayapal, Cicconi, Silvia ORCID: 0000-0001-5507-6203, Evans, Jonathan, Yip, Vincent S, Raraty, Michael, Ghaneh, Paula, Sutton, Robert ORCID: 0000-0001-6600-562X, Neoptolemos, John P and Halloran, Christopher ORCID: 0000-0002-5471-4178
(2019) A systematic review and meta-analysis of metal versus plastic stents for drainage of pancreatic fluid collections: metal stents are advantageous. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 33 (5). pp. 1412-1425.

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Abstract

<h4>Background</h4>The use of fully covered metal stents (FCSEMS) and specifically designed lumen apposing metal stents for transmural drainage of pancreatic fluid collections has become widespread. A systematic review published in 2015 did not support the routine use of metal stents for drainage of pancreatic fluid collections. However, recent studies have shown conflicting data; therefore a systematic review and meta-analysis was performed.<h4>Method</h4>We conducted a database search for original comparative studies between plastic and metal stents. The random effects model was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). Outcomes analysed were clinical success, adverse events and requirement of further intervention.<h4>Results</h4>The search identified 936 studies, 7 studies with 681 (340 metal, 341 plastic) patients met inclusion criteria and were included in the meta-analysis. Clinical success was achieved in 93.8% versus 86.2% in the metal and plastic groups, respectively, RR 1.08 [95% CI 1.02-1.14]; p = 0.009. Adverse events were reduced for metal stents when compared with plastic (10.2% vs. 25.0%), RR 0.42 [95% CI 0.22-0.81]; p = 0.010. Metal stent usage reduced bleeding (2.8% vs. 7.9%), RR 0.37; [95% CI 0.18-0.75]; p = 0.006. Further intervention was required in 12.4% of patients in the metal stent group versus 26.7% for plastic stents, RR 0.54; [95% CI 0.22-1.29]; p = 0.165.<h4>Conclusions</h4>The use of metal stents for drainage of pancreatic fluid collections is associated with improved clinical success, fewer adverse events and reduced bleeding compared to plastic stents.

Item Type: Article
Uncontrolled Keywords: Pancreatic fluid collection, Metal stents, Plastic stents, Endoscopic ultrasound intervention, Pancreatic pseudocyst, Drainage
Depositing User: Symplectic Admin
Date Deposited: 28 Sep 2018 08:44
Last Modified: 19 Jan 2023 06:49
DOI: 10.1007/s00464-018-6416-5
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3013009