Abstract
METAL VERSUS PLASTIC STENTS FOR ENDOSCOPIC-ULTRASOUND GUIDED DRAINAGE OF WALLED-OFF PANCREATIC NECROSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Gastrointestinal endoscopy, Vol.101(5 Supplement), pp.S538-S539
05/01/2025
DOI: 10.1016/j.gie.2025.03.907
Abstract
BACKGROUND
Endoscopic ultrasound (EUS)-guided drainage of walled-off pancreatic necrosis (WOPN), with either metal stents (MS) [self-expanding biflanged metal stent (BFMS) or lumen apposing metal stent (LAMS)] or plastic stents (PS), is the mainstay of management. However, there is limited high-quality data comparing the two modalities. We conducted a meta-analysis of randomized controlled trials (RCTs) comparing MS and PS for EUS-guided WOPN drainage.
METHODS
Multiple databases were searched through November 2024 to identify relevant studies on EUS-guided WOPN drainage. Patient characteristics, technical success, resolution/recurrence rates, direct endoscopic necrosectomy (DEN) rates, hospital length of stay (LOS), adverse events (AEs) and overall mortality were compared. Technical success was defined as successful completion of WOPN drainage. WOPN resolution and recurrence were defined as significant reduction in collection size at maximum follow-up and occurrence of a new collection at maximum follow-up after initial resolution, respectively. Pooled rates (PR) with 95% confidence intervals (CI) were assessed using a random-effects model. Standard mean difference (SMD) and relative risk (RR) were calculated to compare the two techniques.
RESULTS
Five studies with 362 patients (183 MS; 179 PS) were included in the final analysis. The mean age ranged from 39.4-63 years with a male predominance (71.6% MS; 70% PS). In the MS group, 4 studies used LAMS (HotAXIOS stent, Boston Scientific, USA) while one study used BFMS (NAGI; Taewoong Medical, Gyeonggido, South Korea). Overall pooled technical success was comparable between MS: 97.2% (CI 89.4-99.3) and PS: 97.5% (CI 90.6-99.4), RR 1.0 (CI 0.93-1.09; I24.8), p=0.9. However, procedure duration was significantly lower for the MS group compared to the PS group [SMD -1.2 (95% CI -2.07 - -0.32; I290.2), p=0.01]. We found no statistical difference in the PR of WOPN resolution for MS: 88.3% (CI 66.5-96.6; I279) and PS: 90.8% (CI 64.4-98.2; I282), RR 0.98 (CI 0.92-1.05; I20), p=0.65. Furthermore, we found no significant difference in PR of WOPN recurrence, need for DEN and number of DEN performed between the two groups RR 1.49 (CI 0.60-3.7; I20), p=0.39; RR 1.08 (CI 0.82-1.42; I20), p=0.58 and RR 0.2 (CI -0.07-0.47; I20), p=0.15, respectively.
Stent-related AEs for MS [18.2% (CI 7.0-39.5); I277] and PS [13.6% (CI 3.5-40.4); I284.5] were comparable, RR 1.24 (CI 0.48-3.23; I249.3), p=0.66. There was no difference for LOS [RR -0.23 (95% CI -1.0-0.5; I292), p=0.56] and overall morality [RR 0.77 (95% CI 0.36-1.63; I20), p=0.5] between the two groups (Table 1).
CONCLUSION
Our analysis of high-quality RCTs demonstrates that EUS-guided WOPN drainage with either MS or PS is equally safe and effective. However, drainage with MS is associated with significantly reduced procedure times.
Details
- Title: Subtitle
- METAL VERSUS PLASTIC STENTS FOR ENDOSCOPIC-ULTRASOUND GUIDED DRAINAGE OF WALLED-OFF PANCREATIC NECROSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
- Creators
- Dushyant Singh DahiyaSaurabh ChandanShahab R. KhanSmit S. DeliwalaAbdullah AbbasiSagar J. PathakHassam AliAmit RastogiSaurabh ChawlaMaham HayatNatalie CosgroveDeepanshu JainKambiz S. KadkhodayanDennis YangMuhammad K. HasanMustafa Arain
- Resource Type
- Abstract
- Publication Details
- Gastrointestinal endoscopy, Vol.101(5 Supplement), pp.S538-S539
- DOI
- 10.1016/j.gie.2025.03.907
- ISSN
- 0016-5107
- Language
- English
- Date published
- 05/01/2025
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984844346302771
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