A systematic review and meta-analysis of metal versus plastic stents for drainage of pancreatic fluid collections: metal stents are advantageous

被引:46
作者
Saunders, Rebecca [1 ]
Ramesh, Jayapal [2 ]
Cicconi, Silvia [3 ]
Evans, Jonathan [4 ]
Yip, Vincent S. [5 ]
Raraty, Michael [5 ]
Ghaneh, Paula [6 ]
Sutton, Robert [6 ]
Neoptolemos, John P. [7 ]
Halloran, Christopher [6 ]
机构
[1] Royal Liverpool Univ Hosp, Pancreatitis Res Grp, Liverpool, Merseyside, England
[2] Royal Liverpool Univ Hosp, Gastroenterol, Liverpool, Merseyside, England
[3] Univ Liverpool, Liverpool Canc Trials Unit, Liverpool, Merseyside, England
[4] Royal Liverpool Univ Hosp, Radiol, Liverpool, Merseyside, England
[5] Barts Healthcare, HPB Surg, London, England
[6] Univ Liverpool, Inst Translat Med, Liverpool, Merseyside, England
[7] Univ Klinikum Heidelberg, Chirurg Klin, Gen Surg, Heidelberg, Germany
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2019年 / 33卷 / 05期
基金
“创新英国”项目;
关键词
Pancreatic fluid collection; Metal stents; Plastic stents; Endoscopic ultrasound intervention; Pancreatic pseudocyst; Drainage; TRANSMURAL DRAINAGE; NECROSECTOMY; MANAGEMENT; OUTCOMES; THERAPY;
D O I
10.1007/s00464-018-6416-5
中图分类号
R61 [外科手术学];
学科分类号
摘要
BackgroundThe use of fully covered metal stents (FCSEMS) and specifically designed lumen apposing metal stents for transmural drainage of pancreatic fluid collections has become widespread. A systematic review published in 2015 did not support the routine use of metal stents for drainage of pancreatic fluid collections. However, recent studies have shown conflicting data; therefore a systematic review and meta-analysis was performed.MethodWe conducted a database search for original comparative studies between plastic and metal stents. The random effects model was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). Outcomes analysed were clinical success, adverse events and requirement of further intervention.ResultsThe search identified 936 studies, 7 studies with 681 (340 metal, 341 plastic) patients met inclusion criteria and were included in the meta-analysis. Clinical success was achieved in 93.8% versus 86.2% in the metal and plastic groups, respectively, RR 1.08 [95% CI 1.02-1.14]; p=0.009. Adverse events were reduced for metal stents when compared with plastic (10.2% vs. 25.0%), RR 0.42 [95% CI 0.22-0.81]; p=0.010. Metal stent usage reduced bleeding (2.8% vs. 7.9%), RR 0.37; [95% CI 0.18-0.75]; p=0.006. Further intervention was required in 12.4% of patients in the metal stent group versus 26.7% for plastic stents, RR 0.54; [95% CI 0.22-1.29]; p=0.165.ConclusionsThe use of metal stents for drainage of pancreatic fluid collections is associated with improved clinical success, fewer adverse events and reduced bleeding compared to plastic stents.
引用
收藏
页码:1412 / 1425
页数:14
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