Clinical Journal of Gastroenterology

, Volume 10, Issue 5, pp 403–414 | Cite as

Efficacy and safety of metallic stents in comparison to plastic stents for endoscopic drainage of peripancreatic fluid collections: a meta-analysis and trial sequential analysis

  • Rajesh PanwarEmail author
  • Preet Mohinder Singh
Clinical Review


Metallic stents are being increasingly used for endoscopic drainage of peripancreatic fluid collections (PFCs) but their superiority over plastic stents has not been proven. We carried out a meta-analysis to consolidate the results from available studies and to suggest evidence-based recommendations. Studies that compared plastic and metallic stents for endoscopic drainage of PFCs and published before October 2016 were searched. Comparisons were performed for clinical success, adverse events, salvage interventions, mortality, technical success and recurrence. We included six studies with 856 patients (479 in the metallic stent group and 377 in the plastic stent group). The clinical success rate was significantly higher with metallic stents than with plastic stents (Mantel-Haenszel odds ratio [MH-OR] 3.22; 95% CI 1.87–5.54; P < 0.001). The rate of adverse events (MH-OR 0.40; 95% CI 0.24–0.65; P < 0.001) and the need for salvage procedures (MH-OR 0.31; 95% CI 0.13–0.70; P = 0.01) were also significantly lower with the use of metallic stents. Subgroup analysis for the type of PFC also found better results with the metallic stents. The results of Egger’s regression test (X-axis intercept at −0.63, P = 0.47) and funnel plot did not suggest any significant publication bias. We conclude that compared to plastic stents, the use of metallic stents for endoscopic drainage of PFCs is associated with significantly better clinical success and significantly lower rates of adverse events and the need for salvage procedures. However, further high-quality randomized trials are required to confirm these findings.


Endoscopic Pseudocyst Walled-off necrosis Stents Transmural drainage 


Compliance with ethical standards

Conflict of interest

Rajesh Panwar and Preet Mohinder Singh declare that they have no conflict of interest.

Human rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

This study is a meta-analysis of already published studies and hence does not require informed consent.


  1. 1.
    Fotoohi M, D’Agostino HB, Wollman B, et al. Persistent pancreatocutaneous fistula after percutaneous drainage of pancreatic fluid collections: role of cause and severity of pancreatitis. Radiology. 1999;213:573–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Varadarajulu S, Bang JY, Sutton BS, et al. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology. 2013;145:583–90.CrossRefPubMedGoogle Scholar
  3. 3.
    Yamamoto N, Isayama H, Kawakami H, et al. Preliminary report on a new, fully covered, metal stent designed for the treatment of pancreatic fluid collections. Gastrointest Endosc. 2013;77:809–14.CrossRefPubMedGoogle Scholar
  4. 4.
    Nelsen EM, Johnson EA, Walker AJ, et al. Endoscopic ultrasound-guided pancreatic pseudocyst cystogastrostomy using a novel self-expandable metal stent with antimigration system: a case series. Endosc Ultrasound. 2015;4:229–34.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Chandran S, Efthymiou M, Kaffes A, et al. Management of pancreatic collections with a novel endoscopically placed fully covered self-expandable metal stent: a national experience (with videos). Gastrointest Endosc. 2015;81:127–35.CrossRefPubMedGoogle Scholar
  6. 6.
    Bapaye A, Itoi T, Kongkam P, et al. New fully covered large-bore wide-flare removable metal stent for drainage of pancreatic fluid collections: results of a multicenter study. Dig Endosc. 2015;27:499–504.CrossRefPubMedGoogle Scholar
  7. 7.
    Bang JY, Hawes R, Bartolucci A, et al. Efficacy of metal and plastic stents for transmural drainage of pancreatic fluid collections: a systematic review. Dig Endosc. 2015;27:486–98.CrossRefPubMedGoogle Scholar
  8. 8.
    Bang JY, Varadarajulu S. Metal versus plastic stent for transmural drainage of pancreatic fluid collections. Clin Endosc. 2013;46:500–2.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Lee BU, Song TJ, Lee SS, et al. Newly designed, fully covered metal stents for endoscopic ultrasound (EUS)-guided transmural drainage of peripancreatic fluid collections: a prospective randomized study. Endoscopy. 2014;46:1078–84.CrossRefPubMedGoogle Scholar
  10. 10.
    Bapaye A, Dubale NA, Sheth KA, et al. Endoscopic ultrasonography-guided transmural drainage of walled-off pancreatic necrosis: comparison between a specially designed fully covered bi-flanged metal stent and multiple plastic stents. Dig Endosc. 2017; 29(1): 104−110.Google Scholar
  11. 11.
    Mukai S, Itoi T, Baron TH, et al. Endoscopic ultrasound-guided placement of plastic vs. biflanged metal stents for therapy of walled-off necrosis: a retrospective single-center series. Endoscopy. 2015;47:47–55.CrossRefPubMedGoogle Scholar
  12. 12.
    Siddiqui AA, Kowalski TE, Loren DE, et al. Fully covered self-expanding metal stents versus lumen-apposing fully covered self-expanding metal stent versus plastic stents for endoscopic drainage of pancreatic walled-off necrosis: clinical outcomes and success. Gastrointest Endosc. 2017; 85(4): 758−765Google Scholar
  13. 13.
    Sharaiha RZ, DeFilippis EM, Kedia P, et al. Metal versus plastic for pancreatic pseudocyst drainage: clinical outcomes and success. Gastrointest Endosc. 2015;82:822–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Bang JY, Hasan MK, Navaneethan U, et al. Lumen-apposing metal stents for drainage of pancreatic fluid collections: when and for whom? Dig Endosc. 2017;29:83–90.CrossRefPubMedGoogle Scholar
  15. 15.
    Kawakami H, Itoi T, Sakamoto N. Endoscopic ultrasound-guided transluminal drainage for peripancreatic fluid collections: where are we now? Gut Liver. 2014;8:341–55.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Varadarajulu S, Bang JY, Phadnis MA, et al. Endoscopic transmural drainage of peripancreatic fluid collections: outcomes and predictors of treatment success in 211 consecutive patients. J Gastrointest Surg. 2011;15:2080–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Siddiqui AA, Dewitt JM, Strongin A, et al. Outcomes of EUS-guided drainage of debris-containing pancreatic pseudocysts by using combined endoprosthesis and a nasocystic drain. Gastrointest Endosc. 2013;78:589–95.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2017

Authors and Affiliations

  1. 1.All India Institute of Medical SciencesDepartment of Gastrointestinal Surgery and Liver TransplantationNew DelhiIndia
  2. 2.All India Institute of Medical SciencesDepartment of AnesthesiaNew DelhiIndia

Personalised recommendations