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Lumen-apposing metal stents versus traditional self-expanding metal stents for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a systematic review and meta-analysis

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Abstract

Background

Endoscopic drainage has become the preferred treatment for pancreatic fluid collections (PFCs). There is still a lack of reliable evidence to prove which metal stent is the best choice for endoscopic ultrasound (EUS)-guided drainage of PFCs. In this study, we aimed to evaluate the efficacy and safety of lumen-apposing metal stents (LAMS) compared to traditional self-expanding metal stents (SEMS) in meta-analysis.

Methods

We systematically searched PubMed, Embase, Web of Science, and Cochrane Library up to July 15, 2023. Relevant publications that compared LAMS with traditional SEMS for drainage of patients’ PFCs under EUS-guidance were included. This meta-analysis assessed endpoints using Review Manager 5.3 and Stata 14.0 statistical software.

Result

Nine citations comprising 707 patients with PFCs were included. The clinical success rate of LAMS tended to be higher than that of SEMS (RR = 1.07, 95%CI [1.00, 1.15], P = 0.05). LAMS had a lower technical success rate (RR = 0.97, 95%CI [0.94, 0.99], P = 0.02) and faster procedure time (minutes) (MD =  − 24.29, 95%CI [− 25.59, − 22.99], P < 0.00001) compared to SEMS. In addition, LAMS had fewer overall adverse events (RR = 0.64, 95%CI [0.48, 0.87], P = 0.004). For specific adverse events, LAMS had fewer migration (RR = 0.37, 95%CI [0.19, 0.72], P = 0.003), occlusion (RR = 0.43, 95%CI [0.22, 0.82], P = 0.01) and infection (RR = 0.38, 95%CI [0.20, 0.70], P = 0.002). There was no significant difference in bleeding and perforation between the two stents. For hospital stay (days), LAMS group was similar to SEMS group (MD =  − 3.34, 95%CI [− 7.71, − 1.03], P = 0.13). Regarding recurrence, LAMS group was fewer than SEMS group (RR = 0.41, 95%CI [0.21, 0.78], P = 0.007).

Conclusion

Compared to traditional SEMS, LAMS has a higher clinical success rate, faster procedure time, fewer adverse events, similar hospital stay and lower recurrence rate in EUS-guided drainage of PFCs. LAMS is a good choice with a high technical success rate over 95%, and using a shorter length or “one-step” operation can further improve it. Richer placement experience is required for LAMS placement under EUS-guidance.

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Funding

This research was funded by Sichuan Provincial Science and Technology Department, grant number 2021YJ0198, Sichuan Medical Association, Grant Number 2021XHNJ19, and XingLin Scholars Program of Chengdu University of TCM, Grant Number YYZX2020036.

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Authors and Affiliations

  1. Department of Gastroenterology, Chengdu First People’s Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China

    Yong Tian, Yihan Ma, Guochuan Fu, Hongmei Ran, Tao Pan & Xudong Wen

  2. Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China

    Yong Tian, Rui Liu & Yang Xiao

  3. People’s Liberation Army, The General Hospital of Western Theater Command, Chengdu, Sichuan, China

    Changjie Yin

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Yong Tian, Changjie Yin, Yihan Ma, Guochuan Fu, Rui Liu, Hongmei Ran, Tao Pan, Yang Xiao, Xudong Wen have no conflicts of interest or financial ties to disclose.

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Tian, Y., Yin, C., Ma, Y. et al. Lumen-apposing metal stents versus traditional self-expanding metal stents for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a systematic review and meta-analysis. Surg Endosc 38, 586–596 (2024). https://doi.org/10.1007/s00464-023-10636-3

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