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Endoscopy 2024; 56(03): 184-195
DOI: 10.1055/a-2169-0362
Systematic review

Treatment of walled-off necrosis using lumen-apposing metal stents versus plastic stents: a systematic review and meta-analysis of data from randomized trials

Ji Young Bang
1   Digestive Health Institute, Orlando Health, Orlando, United States (Ringgold ID: RIN6246)
,
Charles Melbern Wilcox
1   Digestive Health Institute, Orlando Health, Orlando, United States (Ringgold ID: RIN6246)
,
Udayakumar Navaneethan
1   Digestive Health Institute, Orlando Health, Orlando, United States (Ringgold ID: RIN6246)
,
Robert Holbrook Hawes
1   Digestive Health Institute, Orlando Health, Orlando, United States (Ringgold ID: RIN6246)
,
Shyam Varadarajulu
1   Digestive Health Institute, Orlando Health, Orlando, United States (Ringgold ID: RIN6246)
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Referred to by:

Plastic stents: silenced by the LAMS?Endoscopy 2024; 56(03): 196-197
DOI: 10.1055/a-2234-8541

Abstract

Background Walled-off necrosis (WON) is highly morbid disease most effectively managed by endoscopic drainage with lumen-apposing metal stents (LAMSs) or plastic stents, with or without necrosectomy. This meta-analysis compared the clinical outcomes of patients included in randomized trials treated using LAMSs or plastic stents.

Methods The MEDLINE and EMBASE databases were searched to identify all data collected from randomized trials comparing LAMSs and plastic stents for the treatment of WON. The primary outcome measure was need for endoscopic necrosectomy.

Results Three studies comprising 206 patients met inclusion criteria. Except for procedure duration, which was significantly shorter for LAMSs (standardized mean difference [SMD] −1.22, 95%CI −1.64 to −0.79), there was no significant difference in need for necrosectomy (38.5% vs. 41.2%; risk ratio [RR] 1.07, 95%CI 0.79–1.45), number of interventions (SMD −0.09, 95%CI −0.40 to 0.22), treatment success (90.7% vs. 94.5%; RR 0.96, 95%CI 0.87–1.06), recurrence (4.6% vs. 0.6%; RR 3.73, 95%CI 0.42–33.0), readmission (42.6% vs. 50.2%; RR 0.84, 95%CI 0.62–1.14), length of hospitalization (SMD −0.06, 95%CI −0.55 to 0.43), mortality (8.5% vs. 9.8%; RR 0.70, 95%CI 0.30–1.66), new-onset organ failure (10.6% vs. 14.6%; RR 0.72, 95%CI 0.16–3.32), bleeding (11.0% vs. 10.7%; RR 1.09, 95%CI 0.34–3.44), procedural adverse events (23.6% vs. 19.2%; RR 1.38, 95%CI 0.82–2.33), or overall costs (SMD −0.04, 95%CI −0.31 to 0.24) between LAMSs and plastic stents, respectively.

Conclusions Except for procedure duration, there is no significant difference in clinical outcomes for patients with WON treated using LAMSs or plastic stents.

Supplementary Material



Publication History

Received: 04 March 2023

Accepted after revision: 06 September 2023

Accepted Manuscript online:
06 September 2023

Article published online:
07 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Letter to this article:

Metal versus plastic stents for walled-off pancreatic necrosis: much alike, then which?Endoscopy 2024; 56(04): 317-318
DOI: 10.1055/a-2212-8942

 

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