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Efficacy and safety of long-term indwelling plastic stents after resolution of pancreatic fluid collections with endoscopic transmural drainage: a systematic review and meta-analysis

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Abstract

Background

Pancreatic fluid collections (PFCs) may recur after resolution with endoscopic transmural drainage (ETD) and standard stent removal (SSR). Herein, we compared the efficacy and safety of leaving long-term indwelling plastic stents (LTIS) vs. standard stent removal after PFC resolution with ETD.

Methods

We performed a systematic review of MEDLINE, EMBASE, CINAHL, Scopus, and Cochrane databases from inception to September 2022. Full-text articles comparing long-term (> 6 months) outcomes of LTIS and SSR were eligible, as well as single-arm studies with ≥ 10 patients with LTIS. Two independent reviewers selected studies, extracted data, and assessed the risk of bias using the Newcastle–Ottawa Scale. Measured outcomes included the following: (A) PFC recurrence; (B) interventions for PFC recurrence; (C) technical success; and (D) adverse events (AEs). Meta-analysis was carried out using random-effects models.

Results

We included 16 studies, encompassing 1285 patients. Compared to SSR after PFC resolution with ETD, LTIS was associated with significantly lower risk of PFC recurrence (3% vs. 23%; OR 0.22 [95%CI 0.09–0.52]; I2 = 45%) and need for interventions (2% vs. 14%; OR 0.35 [95%CI 0.16–0.78]; I2 = 0%). The superiority of LTIS on reducing PFC recurrence was found with walled-off necrosis, with or without disconnected pancreatic duct, and with placement of ≥ 2 LTIS. When using LTIS, the pooled proportion of AEs was 8% (95%CI 4–11%) and technical success was 93% (95%CI 86–99%).

Conclusions

Our results show that LTIS after PFC resolution with ETD is feasible, safe, and superior to SSR in reducing the risk of PFC recurrence and need for interventions.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA

    Fadi Hawa, George M. Philips, Richard S. Kwon, Erik-Jan Wamsteker, Allison R. Schulman & Matthew J. DiMagno

  2. Division of Gastroenterology and Hepatology, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA

    Jean M. Chalhoub

  3. Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA

    Ana Vilela

  4. Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA

    Elit Quingalahua

  5. Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA

    Carol Shannon

  6. Division of Gastroenterology and Hepatology, University of Michigan, 1500 E Medical Center Dr, Floor 3 Reception D, Ann Arbor, MI, 48109, USA

    Jorge D. Machicado

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Contributions

Study concept and design: FH, JDM. Statistical analysis: JC. Drafting of the manuscript: FH, JDM. Generation of data: FH, AV. Critical revision of the manuscript: FH, JDM. Data interpretation, final approval of the manuscript: all authors.

Corresponding author

Correspondence to Jorge D. Machicado.

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Disclosures

Jorge D. Machicado is a speaker for Mauna Kea Technologies. The remaining authors (Fadi Hawa, Jean M. Chalhoub, Ana Vilela, Elit Quingalahua, Carol Shannon, George M. Philips, Richard S. Kwon, Erik-Jan Wamsteker, Allison R. Schulman, and Matthew J. DiMagno) have no conflicts of interest or financial ties to disclose.

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Hawa, F., Chalhoub, J.M., Vilela, A. et al. Efficacy and safety of long-term indwelling plastic stents after resolution of pancreatic fluid collections with endoscopic transmural drainage: a systematic review and meta-analysis. Surg Endosc 38, 2350–2358 (2024). https://doi.org/10.1007/s00464-024-10784-0

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