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

• Verfasst von: Saunders, Rebecca J. [VerfasserIn]
• Verfasst von: Neoptolemos, John P. [VerfasserIn]
• Titel: A systematic review and meta-analysis of metal versus plastic stents for drainage of pancreatic fluid collections
• Titelzusatz: metal stents are advantageous
• Verf.angabe: Rebecca Saunders, Jayapal Ramesh, Silvia Cicconi, Jonathan Evans, Vincent S. Yip, Michael Raraty, Paula Ghaneh, Robert Sutton, John P. Neoptolemos, Christopher Halloran
• Jahr: 2019
• Jahr des Originals: 2018
• Umfang: 14 S.
• Fussnoten: First online: 06 September 2018 ; Gesehen am 15.07.2019
• Titel Quelle: Enthalten in: Surgical endoscopy and other interventional techniques
• Ort Quelle: New York, NY : Springer, 1987
• Jahr Quelle: 2019
• Band/Heft Quelle: 33(2019), 5, Seite 1412-1425
• ISSN Quelle: 1432-2218
• DOI: doi:10.1007/s00464-018-6416-5
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Drainage
• Sach-SW: Endoscopic ultrasound intervention
• Sach-SW: Metal stents
• Sach-SW: Pancreatic fluid collection
• Sach-SW: Pancreatic pseudocyst
• Sach-SW: Plastic stents
• K10plus-PPN: 1669129497

Abstract

BackgroundThe 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.MethodWe 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.ResultsThe 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.ConclusionsThe 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.