A systematic review and meta-analysis of metal versus plastic stents for drainage of pancreatic fluid collections: metal stents are advantageous

Abstract

Background: The use of fully covered metal stents (FCSEMS) and specifically designed lumen apposing metal stents for transmural drainage of pancreatic fluid collections has become widespread. A systematic review published in 2015 did not support the routine use of metal stents for drainage of pancreatic fluid collections. However, recent studies have shown conflicting data; therefore a systematic review and meta-analysis was performed.

Method: We conducted a database search for original comparative studies between plastic and metal stents. The random effects model was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). Outcomes analysed were clinical success, adverse events and requirement of further intervention.

Results: The search identified 936 studies, 7 studies with 681 (340 metal, 341 plastic) patients met inclusion criteria and were included in the meta-analysis. Clinical success was achieved in 93.8% versus 86.2% in the metal and plastic groups, respectively, RR 1.08 [95% CI 1.02-1.14]; p = 0.009. Adverse events were reduced for metal stents when compared with plastic (10.2% vs. 25.0%), RR 0.42 [95% CI 0.22-0.81]; p = 0.010. Metal stent usage reduced bleeding (2.8% vs. 7.9%), RR 0.37; [95% CI 0.18-0.75]; p = 0.006. Further intervention was required in 12.4% of patients in the metal stent group versus 26.7% for plastic stents, RR 0.54; [95% CI 0.22-1.29]; p = 0.165.

Conclusions: The use of metal stents for drainage of pancreatic fluid collections is associated with improved clinical success, fewer adverse events and reduced bleeding compared to plastic stents.

Keywords: Drainage; Endoscopic ultrasound intervention; Metal stents; Pancreatic fluid collection; Pancreatic pseudocyst; Plastic stents.

Fig. 1

PRISMA flow chart of search [16]

Fig. 2

Forest plot for individual and pooled risk ratio of clinical success

Fig. 3

Forest plot showing individual and pooled risk ratios of clinical success for pseudocysts and walled-off necrosis

Fig. 4

Forest plot for individual and pooled risk ratio of adverse events

Fig. 5

Forest plot for individual and pooled risk ratio of bleeding

Fig. 6

Forest plot showing individual and pooled risk ratios for adverse events for pseudocysts and walled-off necrosis

Fig. 7

Forest plot for individual and pooled risk ratio for reintervention

Fig. 8

Forest plot showing individual and pooled risk ratios for reintervention in walled-off necrosis