Metal stents versus plastic stents for the management of pancreatic walled-off necrosis: A systematic review and meta-analysis

Fateh Bazerbachi, Tarek Sawas, Eric J. Vargas, Larry J. Prokop, Suresh T Chari, Ferga C. Gleeson, Michael J. Levy, John Martin, Bret Thomas Petersen, Randall K. Pearson, Mark Topazian, Santhi Swaroop Vege, Barham K. Abu Dayyeh

Research output: Contribution to journalArticle

33 Scopus citations

Abstract

Background and Aims: Endoscopic transluminal drainage of symptomatic walled-off necrosis (WON) is a good management option, although the optimal choice of drainage site stent is unclear. We performed a systematic review and meta-analysis to compare metal stents (MSs) and plastic stents (PSs) in terms of WON resolution, likelihood of resolution after 1 procedure, and adverse events. Methods: An expert librarian queried several databases to identify studies that assessed WON management, and selection was according to a priori criteria. Publication bias, heterogeneity, and study quality were evaluated with the appropriate tools. We performed single and 2-arm meta-analyses for noncomparative and comparative studies using event rate random-effects model and odds ratio (OR)/difference in means, respectively. Results: We included 41 studies involving 2213 patients. In 2-arm study meta-analysis, WON resolution was more likely with MSs compared with PSs (OR, 2.8; 95% confidence interval, 1.7-4.6; P < .001). Resolution with a single endoscopic procedure was similar between stents (47% vs 44%), although for those cases requiring more than 1 intervention, the MS group had fewer interventions, favored by a mean difference of -.9 procedures (95% CI, -1.283 to -.561). In single-arm study meta-analysis, when compared with PSs, MS use was associated with lower bleeding (5.6% vs 12.6%; P = .02), a trend toward lower perforation and stent occlusion (2.8% vs 4.3%, P = .2, and 9.5% vs 17.4%, P = .07), although with higher migration (8.1% vs 5.1%; P = .1). Conclusion: Evidence suggests that MSs are superior for WON resolution, with fewer bleeding events, trend toward less occlusion and perforation rate, but increased migration rate compared with PSs.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
DOIs
StateAccepted/In press - 2017

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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    Bazerbachi, F., Sawas, T., Vargas, E. J., Prokop, L. J., Chari, S. T., Gleeson, F. C., Levy, M. J., Martin, J., Petersen, B. T., Pearson, R. K., Topazian, M., Vege, S. S., & Abu Dayyeh, B. K. (Accepted/In press). Metal stents versus plastic stents for the management of pancreatic walled-off necrosis: A systematic review and meta-analysis. Gastrointestinal Endoscopy. https://doi.org/10.1016/j.gie.2017.08.025