Timing of stent removal does not affect safety after EUS-guided drainage of pancreatic fluid collections with lumen-apposing metal stents: a systematic review and meta-analysis

Aims Lumen-apposing metal stents (LAMS) are widely used for endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs). Safety is a major concern and the timing for LAMS removal is debated due to the risk of adverse events (AEs). Previous studies indicate that early stent removal is associated with a reduced risk of AEs, but data are still conflicting. The aim of this systematic review with meta-analysis is to identify the optimal timing for LAMS removal.

Methods Major databases were systematically searched through May 2024. The primary outcome was the incidence of AEs after early (within 3-4 weeks) vs late (after 3-4 weeks) LAMS removal. A random-effects (DerSimonian-Laird) model was used to pool the results.

Results 8 studies (1820 patients) were included in the analysis. The mean age ranged from 54 to 61.6 years and 63% of patients were males (n=1147). PFCs included walled-off necrosis (WON) (58.2%) and pseudocysts (PC) (41.7%). Pooled LAMS-related AEs rate were similar in the late vs early removal group (RR, 1.29; 95%-CI=0.63-2.64; P=0.48). Sensitivity analysis, including only studies applying a 4-week cut-off, confirmed a comparable AEs rate (RR, 1.05; 95%-CI=0.58-1.89; P=0.87). The mean follow-up of the studies was 190 days.

Conclusions This meta-analysis shows no significant difference in AEs between early and late removal of LAMS in the presence of moderate heterogeneity across studies. Removal within 4 weeks is not warranted and it may be planned based on a clinical case-by-case basis according on the patient's condition.

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Artikel online veröffentlicht:
27. März 2025