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Lumen-Apposing Metal Stent With and Without Concurrent Double-Pigtail Plastic Stent for Pancreatic Fluid Collections:
Azizullah Beran1, Mouhand F H Mohamed2, Thaer Abdelfattah3
1Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN 46204, USA.
Gastroenterology Research
|May 15, 2023
Summary
Concurrent double-pigtail plastic stent (DPPS) deployment with lumen-apposing metal stents (LAMSs) for pancreatic fluid collection (PFC) drainage showed similar efficacy and safety compared to LAMS alone. Further randomized trials are needed to confirm these findings, particularly for walled-off pancreatic necrosis.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Surgical Oncology
Background:
- Lumen-apposing metal stents (LAMSs) are standard for draining pancreatic fluid collections (PFCs).
- Adverse events like obstruction, infection, and bleeding can occur with LAMSs.
- Concurrent double-pigtail plastic stent (DPPS) deployment is proposed to mitigate LAMS-related complications.
Purpose of the Study:
- To compare the clinical outcomes of LAMS with DPPS versus LAMS alone for PFC drainage.
- To evaluate the efficacy and safety of combined stent strategies in managing PFCs.
Main Methods:
- A meta-analysis of published literature was performed.
- Eligible studies comparing LAMS with DPPS versus LAMS alone for PFC drainage were included.
- Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effect model.
Main Results:
- Five studies with 281 patients (137 LAMS+DPPS, 144 LAMS alone) were analyzed.
- Both strategies demonstrated comparable technical and clinical success rates.
- The LAMS with DPPS group showed a trend towards fewer adverse events, including stent occlusion, infection, and perforation, though not statistically significant.
Conclusions:
- Concurrent DPPS deployment with LAMS for PFC drainage does not significantly alter efficacy or safety outcomes.
- Further randomized controlled trials are warranted to validate these findings, especially in cases of walled-off pancreatic necrosis.
