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.

Autor: Hawa F; Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA., Chalhoub JM; Division of Gastroenterology and Hepatology, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA., Vilela A; Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA., Quingalahua E; Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA., Shannon C; Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA., Philips GM; Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA., Kwon RS; Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA., Wamsteker EJ; Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA., Schulman AR; Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA., DiMagno MJ; Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA., Machicado JD; Division of Gastroenterology and Hepatology, University of Michigan, 1500 E Medical Center Dr, Floor 3 Reception D, Ann Arbor, MI, 48109, USA. machicad@med.umich.edu.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2024 May; Vol. 38 (5), pp. 2350-2358. Date of Electronic Publication: 2024 Mar 20.
DOI: 10.1007/s00464-024-10784-0
Abstrakt: 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]; I 2  = 45%) and need for interventions (2% vs. 14%; OR 0.35 [95%CI 0.16-0.78]; I 2  = 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.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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