Shen Yonghua, Liu Mingdong, Chen Min, Li Yunhong, Lu Ying, Zou Xiaoping
Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, PR China.
Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, PR China.
Pancreatology. 2014 Mar-Apr;14(2):87-90. doi: 10.1016/j.pan.2013.12.005. Epub 2014 Jan 8.
Refractory chronic pancreatitis has been proposed as a challenge for endoscopists following routine single plastic stenting. However, data on the efficacy and safety of further endoscopic stenting are still controversial. The current systematic review aimed to assess the efficacy and safety of placement of fully covered self-expandable metal stent (FCSEMS) and multiple plastic stents.
Databases including MEDLINE, EMBASE, the Cochrane Library, CBM, CNKI, VIP, and WANFANG Database were used to search relevant trials. Published studies were assessed by using well-defined inclusion and exclusion criteria. The process was independently performed by two investigators.
A total of 5 studies provided data of 80 patients. Forest plots and publication bias were not carried out because few studies were relevant and screened studies were all case series. The technical success rate was 100% both in placement of FCSEMS and multiple plastic stents. The functional success rate after placement of FCSEMS was 100%, followed by multiple plastic stents (94.7%). Complications occurred 26.2% after FCSEMS placement, which was not described in detail in multiple plastic stents. The stent migration rate was 8.2% for FCSEMS and 10.5% for multiple plastic stents. Reintervention rate was 9.8% for FCSEMS and 15.8% for multiple plastic stents. Pain improvement rate was 85.2% for FCSEMS and 84.2% for multiple plastic stents.
FCSEMS appeared to be no significant difference with multiple plastic stents in treatment of refractory chronic pancreatitis. We need to develop more investigations.
难治性慢性胰腺炎被认为是内镜医师在常规单根塑料支架置入术后面临的一项挑战。然而，关于进一步内镜下支架置入术的疗效和安全性的数据仍存在争议。本系统评价旨在评估全覆膜自膨式金属支架（FCSEMS）和多根塑料支架置入的疗效和安全性。
使用包括MEDLINE、EMBASE、Cochrane图书馆、中国生物医学文献数据库（CBM）、中国知网（CNKI）、维普资讯（VIP）和万方数据库在内的数据库检索相关试验。采用明确的纳入和排除标准对已发表的研究进行评估。该过程由两名研究者独立进行。
共有5项研究提供了80例患者的数据。由于相关研究较少且筛选出的研究均为病例系列，因此未绘制森林图和进行发表偏倚分析。FCSEMS和多根塑料支架置入术的技术成功率均为100%。FCSEMS置入后的功能成功率为100%，其次为多根塑料支架（94.7%）。FCSEMS置入后并发症发生率为26.2%，多根塑料支架置入后的并发症情况未详细描述。FCSEMS的支架移位率为8.2%，多根塑料支架为10.5%。FCSEMS的再次干预率为9.8%，多根塑料支架为15.8%。FCSEMS的疼痛改善率为85.2%，多根塑料支架为84.2%。
在难治性慢性胰腺炎的治疗中，FCSEMS与多根塑料支架相比似乎没有显著差异。我们需要开展更多的研究。
