Safety and efficacy of lumen-apposing metal stents and double-pigtail plastic stents for endoscopic ultrasound-guided drainage of walled-off necrosis; a systematic review and meta-analysis

Hayat Khizar; Hu Yufei; Wu Yanhua; Chen Wangyang; Bian Ying; Le Chenyu; Huang Zhicheng; Kamran Ali; Yang Jianfeng

doi:10.1080/07853890.2022.2164048

Safety and efficacy of lumen-apposing metal stents and double-pigtail plastic stents for endoscopic ultrasound-guided drainage of walled-off necrosis; a systematic review and meta-analysis

Ann Med. 2023 Dec;55(1):578-591. doi: 10.1080/07853890.2022.2164048.

Authors

Hayat Khizar^{1

2}, Hu Yufei³, Wu Yanhua³, Chen Wangyang², Bian Ying³, Le Chenyu³, Huang Zhicheng³, Kamran Ali⁴, Yang Jianfeng^{2

5

6

7}

Affiliations

¹ Department of Gastroenterology, International Education College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
² Department of Gastroenterology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
³ Department of Gastroenterology, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
⁴ Department of Oncology, The Fourth Affiliated Hospital, International Institute of Medicine, Zhejiang University School of Medicine, Hangzhou, China.
⁵ Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Hangzhou, China.
⁶ Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, China.
⁷ Hangzhou Institute of Digestive Diseases, Hangzhou, China.

Abstract

Background: Patients with walled-off necrosis (WON) are still challenging to treat safely and effectively. Recently, double-pigtail plastic stents (DPS), bi-flanged metallic stents (BFMS), and lumen-apposing metal stents (LAMS) have been employed with endoscopic ultrasound-guided (EUS-guided) drainage. However, there is little solid evidence to support the effectiveness and safety of using stents. This study aims to compare the outcomes of the LAMS and the PS.

Method: Till July 2022, a thorough database search was done, and studies that met the criteria were chosen. By using the RevMan software, the technical and clinical success and other secondary outcomes were calculated. Subgroup analysis was performed between the LAMS and the BFMS.

Results: Fifteen studies (two randomized controlled trials and thirteen observational) with 687 patients receiving metal stents and 771 patients receiving plastic stents were selected for final analysis. There was no significant risk of bias or publication bias. The odds ratios (OR) for technical and clinical success were 0.36 (95% confidence interval (95% CI) 0.08, 1.52) and 2.26 (95%CI 1.62, 3.15), respectively. The OR for overall adverse events was 0.74 (95% CI 0.41, 1.34). In subgroup analysis, the LAMS and the BFMS showed the same outcomes.

Conclusion: Compared to DPS, LAMS had better clinical outcomes and fewer side effects when treating patients with WON.

Keywords: EUS-guided drainage; Lumen-apposing metal stents; meta-analysis; plastic stent; walled-off necrosis.

Plain language summary

What is the best endoscopic treatment option for the walled-off necrosis (WON)?A brief comparison of lumen-apposing metal stents (LAMS), bi-flanged metallic stents (BFMS) and double-pigtail plastic stents (DPS) for the treatment of WON patients.How can we limit the adverse events and provide better treatment.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Drainage / adverse effects
Humans
Necrosis / etiology
Plastics*
Retrospective Studies
Stents* / adverse effects
Treatment Outcome
Ultrasonography, Interventional / adverse effects

Substances

Plastics

Grants and funding

This study was supported by grants from the Zhejiang Health Committee [2021ZH003], Hangzhou Science and Technology Commission [202004A14], and the Construction Fund of Medical Key Disciplines of Hangzhou [OO20190001].