Panwar Rajesh, Singh Preet Mohinder
All India Institute of Medical Sciences, Department of Gastrointestinal Surgery and Liver Transplantation, New Delhi, 110029, India.
All India Institute of Medical Sciences, Department of Anesthesia, New Delhi, 110029, India.
Clin J Gastroenterol. 2017 Oct;10(5):403-414. doi: 10.1007/s12328-017-0763-y. Epub 2017 Jul 18.
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.
金属支架越来越多地用于胰周液体积聚（PFC）的内镜引流，但尚未证实其优于塑料支架。我们进行了一项荟萃分析，以整合现有研究的结果并提出基于证据的建议。检索了2016年10月之前发表的比较塑料和金属支架用于PFC内镜引流的研究。对临床成功率、不良事件、挽救性干预措施、死亡率、技术成功率和复发情况进行了比较。我们纳入了6项研究，共856例患者（金属支架组479例，塑料支架组377例）。金属支架的临床成功率显著高于塑料支架（曼特尔-亨泽尔优势比[MH-OR] 3.22；95%可信区间1.87-5.54；P < 0.001）。使用金属支架时，不良事件发生率（MH-OR 0.40；95%可信区间0.24-0.65；P < 0.001）和挽救性治疗需求（MH-OR 0.31；95%可信区间0.13-0.70；P = 0.01）也显著更低。PFC类型的亚组分析也发现金属支架的效果更好。埃格回归检验结果（X轴截距为-0.63，P = 0.47）和漏斗图未显示任何显著的发表偏倚。我们得出结论，与塑料支架相比，使用金属支架进行PFC内镜引流的临床成功率显著更高，不良事件发生率和挽救性治疗需求显著更低。然而，需要进一步的高质量随机试验来证实这些发现。
