Abstract
Background and Aims Recently, a new type of metal stent, named lumen-apposing metal stents (LAMS), has been designed to manage pancreatic fluid collections (PFC), and a few studies have reported its efficacy and safety. Therefore, we conducted this meta-analysis to investigate the role of LAMS for PFC. Methods We searched the studies from PubMed, MEDLINE, Embase, and Cochrane databases from inception to May 2019. We extracted the data and analyzed the technical success, clinical success, and adverse events of LAMS to evaluate its efficacy and safety. Results Twenty studies with 1534 patients were included. The pooled technical success, clinical success, and adverse event rates of LAMS for PFC were 96.2% (95% confidence interval (CI): 94.6%-97.4%), 86.8% (95% CI: 83.1%-89.8%), and 20.7% (95% CI: 16.1%-26.1%), respectively. Eight studies including 875 patients compared the clinical outcomes of LAMS with plastic stents. The pooled risk ratio (RR) of technical success and clinical success for LAMS and plastic stent was 1.01 (95% CI: 0.98-1.04, P = 0.62) and 1.06 (95% CI: 1.01-1.12, P = 0.03), respectively. As for the overall adverse events, the pooled RR was 1.51 (95% CI: 0.67-3.44, P = 0.32). Conclusions Our current study revealed that LAMS has advantages over plastic stents for PFC, with higher clinical success rate and lower complication rate of infection and occlusion.
Highlights
Pancreatic fluid collection (PFC) is a common complication of pancreatitis
Due to the limitations associated with these techniques [2,3,4] and recent advancements in minimally invasive techniques, endoscopic ultrasound- (EUS-) guided transmural drainage has emerged as a new form of therapy for pancreatic fluid collections (PFC) [5, 6]
The search terms for PubMed were focused on lumenapposing metal stents, pancreatic fluid collections, metal stents, pancreatic pseudocyst, walled-off necrosis, AXIOS, lumen-apposing metal stents (LAMS), and WON (Table S1)
Summary
Pancreatic fluid collection (PFC) is a common complication of pancreatitis. According to revised Atlanta Criteria, PFC can be divided into pancreatic pseudocysts (PPs) and walled-off necrosis (WON) [1]. Khan et al reported that EUS-guided transmural drainage conveys several advantages, including a significantly higher rate of clinical success, reduced rates of reintervention, and a shorter period of hospitalization in comparison with percutaneous drainage [8]. EUS-guided drainage has been conventionally performed for PFC with a plastic stent and a fully covered self-expanding metal stent. A number of studies have since shown that LAMS provides an excellent tool for PFC drainage and has several clinical advantages over plastic stents [9, 10]. LAMS has a high risk of complications [14] We performed this updated meta-analysis to evaluate the precise role of LAMS for PFC
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