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

Rebecca Saunders,Michael Raraty,Paula Ghaneh,Vincent S Yip,Robert Sutton,Jayapal Ramesh,Christopher Halloran,Jonathan Evans,John P Neoptolemos,Silvia Cicconi

doi:10.1007/s00464-018-6416-5

Abstract

BackgroundThe 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.MethodWe 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.ResultsThe 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.ConclusionsThe 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.

Highlights

The use of fully covered metal stents (FCSEMS) and designed lumen apposing metal stents for transmural drainage of pancreatic fluid collections has become widespread
The graphs do not reflect any publication bias and Egger’s regression tests for asymmetry yielded statistically non-significant p-values. This meta-analysis demonstrates superior clinical success and reduced adverse events for use of metal stents when compared to plastic for endoscopic transluminal drainage of pancreatic fluid collections
Previous metaanalysis by Bang et al showed no difference in the efficacy and adverse events between plastic and metal stents for

Summary

Introduction

The use of fully covered metal stents (FCSEMS) and 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. Outcomes analysed were clinical success, adverse events and requirement of further intervention. 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. 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

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Conclusion