Sustained Transmural Drainage with Plastic Stents After LAMS Removal in Disconnected Pancreatic Duct Syndrome:...

Disconnected pancreatic duct syndrome (DPDS) is a common sequela of necrotizing pancreatitis, often leading to recurrent peripancreatic fluid collections (PFCs) after transmural drainage. The long-term placement of double-pigtail plastic stents (DPS) following lumen-apposing metal stent (LAMS) removal has been proposed to maintain drainage and prevent recurrence. This study aimed to evaluate the efficacy and safety of DPS maintenance in patients with DPDS.

A systematic review and meta-analysis was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251167723) . MEDLINE, EMBASE, and SCOPUS were searched for comparative studies including adult patients with DPDS who underwent endoscopic transmural drainage with or without DPS maintenance. We included observational cohorts studies and a randomized clinical trial. The primary outcome was PFC recurrence; secondary outcomes included reintervention and adverse events.

Seven studies (n=597) met inclusion criteria. PFC recurrence was significantly lower with DPS maintenance than without (2.9% vs. 22.6%; OR 0.11; 95% CI 0.05-0.26; I²=27%). DPS placement also reduced reintervention rates (5.8% vs. 12.6%; OR 0.28; 95% CI 0.09-0.85; I²=8.2%). Adverse events occurred in 8.25% of cases, mostly asymptomatic stent migration.

Long-term DPS placement after LAMS removal appears to be associated with lower recurrence and need for reintervention in patients with DPDS, without major safety concerns.