Stent occlusion and migration rates of lumen-apposing metal stents (LAMS) with and without co-axial double-pigtail plastic stents (DPPS) for drainage of walled-off necrosis (WON) and pancreatic pseudocysts (PP): an updated systematic review and meta-analy

Aims LAMS are an effective method for endoscopic drainage of WON and PP. Nevertheless, occlusion, migration, and bleeding are potential LAMS-related AEs. Co-axial double-pigtail plastic stents (DPPS) may mitigate these risks, but their benefit remains unclear.

Methods Following the PRISMA guidelines, a systematic review and meta-analysis were performed to determine the impact of concomitant utilization of co-axial DPPS in LAMS on the frequency of AEs in patients with pancreatic fluid collections, particularly WON. Primary outcomes were LAMS occlusion, migration, and bleeding. Data were analyzed using R version 4.2.2. The Robins-I and RoB 2 tools assessed the risk of bias. The quality of evidence was graded using the Newcastle-Ottawa guidelines.

Results One RCT and two observational studies described the stent occlusion rate of LAMS+DPPS vs. LAMS alone for managing WON, totaling 125 patients. Meta-analysis test for overall effect showed a statistical difference, demonstrating a decreased rate in the LAMS+DPPS group (RR=0.37; 95% CI=[0.2-0.69]; p=0.02). Similarly, in terms of the stent occlusion rate for all pancreatic fluid collections (WON and PP); one RCT and five observational studies totaling 429 patients were included; a statistically significant difference within groups with a decreased rate in the LAMS+DPPS group was found (RR=0.55; 95% CI=[0.32-0.93]; p=0.03). Conversely, one RCT and five observational describing the stent migration rate totaling 486 patients, showed no statistically significant difference (RR=0.92; 95% CI=[0.23-3.65]; p=0.87), as well as no statistical difference in terms of bleeding rate for both groups (RR=0.89; 95% CI=[0.31-2.51]; p=0.78). The clinical and technical success rates were comparable between groups. The risk of bias was low, with moderate-to-high-quality evidence amongst the included studies.

Conclusions Our updated systematic review and meta-analysis demonstrate a statistically significant decreased rate of stent occlusion when LAMS was associated with the use of a coaxial DPPS for the endoscopic transluminal drainage for all pancreatic fluid collections (WON and PP). This technique may be beneficial in preventing LAMS occlusion and should be considered whenever feasible. The rates of migration and bleeding were not significantly different amongst groups. Further randomized studies are needed to confirm these findings.

Publication History

Article published online:
27 March 2025