Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Library Services, Mayo Clinic, Rochester, Minnesota, USA.
Gastrointest Endosc. 2018 Jan;87(1):30-42.e15. doi: 10.1016/j.gie.2017.08.025. Epub 2017 Sep 1.
Endoscopic transluminal drainage of symptomatic walled-off necrosis (WON) is a good management option, although the optimal choice of drainage site stent is unclear. We performed a systematic review and meta-analysis to compare metal stents (MSs) and plastic stents (PSs) in terms of WON resolution, likelihood of resolution after 1 procedure, and adverse events.
An expert librarian queried several databases to identify studies that assessed WON management, and selection was according to a priori criteria. Publication bias, heterogeneity, and study quality were evaluated with the appropriate tools. We performed single and 2-arm meta-analyses for noncomparative and comparative studies using event rate random-effects model and odds ratio (OR)/difference in means, respectively.
We included 41 studies involving 2213 patients. In 2-arm study meta-analysis, WON resolution was more likely with MSs compared with PSs (OR, 2.8; 95% confidence interval, 1.7-4.6; P < .001). Resolution with a single endoscopic procedure was similar between stents (47% vs 44%), although for those cases requiring more than 1 intervention, the MS group had fewer interventions, favored by a mean difference of -.9 procedures (95% CI, -1.283 to -.561). In single-arm study meta-analysis, when compared with PSs, MS use was associated with lower bleeding (5.6% vs 12.6%; P = .02), a trend toward lower perforation and stent occlusion (2.8% vs 4.3%, P = .2, and 9.5% vs 17.4%, P = .07), although with higher migration (8.1% vs 5.1%; P = .1).
Evidence suggests that MSs are superior for WON resolution, with fewer bleeding events, trend toward less occlusion and perforation rate, but increased migration rate compared with PSs.
内镜经腔道引流有症状的包裹性坏死（WON）是一种很好的治疗选择，尽管最佳的引流部位支架选择尚不清楚。我们进行了一项系统评价和荟萃分析，比较了金属支架（MS）和塑料支架（PS）在 WON 缓解、1 次治疗后缓解的可能性以及不良事件方面的差异。
一位专家级图书管理员检索了多个数据库，以确定评估 WON 治疗的研究，并根据预先确定的标准进行选择。使用适当的工具评估发表偏倚、异质性和研究质量。我们对非比较性和比较性研究分别进行了单组和 2 组荟萃分析，使用事件率随机效应模型和优势比（OR）/均值差异。
我们纳入了 41 项研究，涉及 2213 名患者。在 2 组研究的荟萃分析中，与 PS 相比，MS 更有可能使 WON 得到缓解（OR，2.8；95%置信区间，1.7-4.6；P<0.001）。虽然单支架治疗后缓解情况相似（47%与 44%），但对于需要超过 1 次干预的病例，MS 组的干预次数更少，优势为平均减少 -0.9 次（95%CI，-1.283 至 -0.561）。在单组研究的荟萃分析中，与 PS 相比，MS 组的出血发生率较低（5.6%与 12.6%；P=0.02），穿孔和支架阻塞的发生率也有降低的趋势（2.8%与 4.3%，P=0.2；9.5%与 17.4%，P=0.07），但支架迁移率较高（8.1%与 5.1%；P=0.1）。
证据表明，与 PS 相比，MS 更有利于 WON 的缓解，其出血事件更少，穿孔和阻塞的发生率较低，但迁移率较高。
