Department of Medicine, Hofstra Northwell School of Medicine, Northwell Health System, Division of Gastroenterology, North Shore University Hospital, Manhasset, NY.
J Clin Gastroenterol. 2018 Oct;52(9):835-844. doi: 10.1097/MCG.0000000000000934.
Endoscopic ultrasound-guided transmural drainage using lumen apposing metal stents (LAMSs) is becoming a popular and promising therapeutic approach for drainage of intra-abdominal fluid collections. There has been an increasing number of studies evaluating LAMS for drainage of pancreatic pseudocysts (PP), walled-off pancreatic necrosis (WOPN), and gallbladder (GB) drainage. The aim of this meta-analysis is to analyze the literature to date regarding the clinical success, technical success, and adverse events of LAMS in treatment of pancreatic fluid collections and GB drainage.
A comprehensive search of multiple literature databases through November 2016 was performed. Human studies with at least 10 subjects that examined the clinical success, technical success, and adverse events of LAMS in treating PP, WOPN, and GB drainage were included.
A total of 993 patients (608-WOPN; 204-PP; 181-GB drainage) underwent drainage from 20 trials. For drainage of WOPN, the pooled technical success was 98.9% [95% confidence interval (CI): 98.2% to 99.7%] and clinical success was 90% (95% CI: 87% to 93%) (τ=0.001). For drainage of PP, the pooled technical success was 97% (95% CI: 95% to 99%) and clinical success was 98% (95% CI: 96% to 100%), (τ=0.001). For GB drainage, the pooled technical success was 95% (95% CI: 91% to 99%) and clinical success was 93% (95% CI: 90% to 97%), (τ=0.001). Total adverse events occurred in 11% of patients with higher complication rates observed in GB drainage. There was no evidence of publication bias in this meta-analysis.
Endoscopic ultrasound-guided transmural drainage using LAMS is becoming a widely accepted therapeutic approach for the treatment of PP, WOPN, and GB drainage with high clinical and technical success rates and acceptable adverse events. Further prospective randomized trials reporting long-term clinical efficacy and cost-effectiveness are needed to validate LAMS as a therapeutic modality for pancreatic and GB collections.
内镜超声引导下经壁腔内置入金属支架（LAMS）引流术已成为治疗腹腔内积液的一种流行且有前途的治疗方法。越来越多的研究评估了 LAMS 引流胰腺假性囊肿（PP）、包裹性胰腺坏死（WOPN）和胆囊（GB）引流的效果。本荟萃分析的目的是分析迄今为止有关 LAMS 治疗胰腺液体积聚和 GB 引流的临床成功率、技术成功率和不良事件的文献。
通过 2016 年 11 月对多个文献数据库进行全面检索。纳入了至少有 10 例受试者的人类研究，这些研究检查了 LAMS 在治疗 PP、WOPN 和 GB 引流中的临床成功率、技术成功率和不良事件。
共有 993 例患者（608 例 WOPN；204 例 PP；181 例 GB 引流）参与了 20 项试验。对于 WOPN 的引流，汇总的技术成功率为 98.9%[95%置信区间（CI）：98.2%至 99.7%]，临床成功率为 90%（95%CI：87%至 93%）（τ=0.001）。对于 PP 的引流，汇总的技术成功率为 97%（95%CI：95%至 99%），临床成功率为 98%（95%CI：96%至 100%）（τ=0.001）。对于 GB 的引流，汇总的技术成功率为 95%（95%CI：91%至 99%），临床成功率为 93%（95%CI：90%至 97%）（τ=0.001）。11%的患者发生了总不良事件，GB 引流的并发症发生率较高。本荟萃分析未发现发表偏倚的证据。
内镜超声引导下经壁腔内置入 LAMS 引流术已成为治疗 PP、WOPN 和 GB 引流的广泛接受的治疗方法，具有较高的临床和技术成功率以及可接受的不良事件。需要进一步的前瞻性随机试验来报告长期的临床疗效和成本效益，以验证 LAMS 作为胰腺和 GB 积聚的治疗方法。
