Clin Endosc.  2024 Sep;57(5):595-603. 10.5946/ce.2023.297.

Coaxial plastic stent placement within lumen-apposing metal stents for the management of pancreatic fluid collections: a systemic review and meta-analysis

• AbiMansour J
• Jaruvongvanich V
• Velaga S
• Law R
• Storm AC
• Topazian M
• Levy MJ
• Alexander R
• Vargas EJ
• Bofill-Garica A
• Martin JA
• Petersen BT
• Abu Dayyeh BK
• Chandrasekhara V

• KMID: 2559208
• DOI: http://doi.org/10.5946/ce.2023.297

Abstract

Background/Aims
Coaxial placement of double pigtail plastic stents (DPPS) through lumen-apposing metal stents (LAMSs) is commonly performed to reduce the risk of LAMS obstruction, bleeding, and stent migration when used for the drainage of pancreatic fluid collections (PFCs). A systematic review and meta-analysis were performed to compare the outcomes of LAMS alone and LAMS with coaxial DPPS placement in the management of PFCs.
Methods
A systematic review was conducted to identify studies comparing LAMS and LAMS/DPPS for PFC drainage. Primary outcomes included the rate of clinical success, overall adverse events (AEs), bleeding, infection, occlusion, and stent migration. The pooled effect size was summarized using a random-effects model and compared between LAMS and LAMS/DPPS by calculating odds ratios (ORs).
Results
Nine studies involving 709 patients were identified (338 on LAMS and 371 on LAMS/DPPS). LAMS/DPPS was associated with a reduced risk of stent obstruction (OR, 0.59; p=0.004) and infection (OR, 0.55; p=0.001). No significant differences were observed in clinical success (OR, 0.96; p=0.440), overall AEs (OR, 0.57; p=0.060), bleeding (OR, 0.61; p=0.120), or stent migration (OR, 1.03; p=0.480).
Conclusions
Coaxial DPPS for LAMS drainage of PFCs is associated with a reduced risk of stent occlusion and infection; however, no difference was observed in the overall AE rates or bleeding.

Keyword

Acute necrotizing pancreatitis; Chronic; Endosonography; Fat necrosis, Pancreatic pseudocyst; Pancreatitis; Peripancreatic

Figure

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  Fig. 1. Pooled odds ratio (OR) for (A) clinical success, (B) technical success, (C) overall adverse events, (D) occlusion, (E) infection, (F) bleeding, and (G) migration. CI, confidence interval; LAMS, lumen-apposing metal stent; DPPS, double pigtail plastic stent; AE, adverse event.

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