Mohan Babu P, Jayaraj Mahendran, Asokkumar Ravishankar, Shakhatreh Mohammed, Pahal Parul, Ponnada Suresh, Navaneethan Udayakumar, Adler Douglas G
Department of Inpatient Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona, USA.
Division of Gastroenterology/Hepatology, University of Nevada, Las Vegas, USA.
Endosc Ultrasound. 2019 Mar-Apr;8(2):82-90. doi: 10.4103/eus.eus_7_19.
Lumen-apposing metal stents (LAMS) are increasingly being used in the drainage of pancreatic walled-off necrosis (WON). Best choice of stent is subject to argument, and studies are varied in the reported outcomes between LAMS and plastic stents (PS) to this end. We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, and Web of Science databases (earliest inception through July 2018) to identify studies that reported on the use of LAMS and PS in WON drainage. Studies published since the release of the revised Atlanta classification for pancreatic fluid collections (2014 to current) were included in the analysis. The outcomes were to estimate and compare the pooled rates of clinical success, and adverse-events. A total of 9 studies (737 patients) for LAMS and 6 studies (527 patients) for PS were included in the analysis. The pooled rate of clinical-success with LAMS was 88.5% (95% CI 82.5-92.6, I = 71.7) and with PS was 88.1% (95% CI 80.5-93.0, I = 78.1) and the difference was not statistically significant, P = 0.93. No difference was noted in the pooled rates of all adverse-events, LAMS: 11.2% (6.8-17.9, I = 82.0); vs PS: 15.9% (8.4-27.8, I = 78.8); P = 0.38. Based on our meta-analysis, LAMS and PS demonstrate equal clinical outcomes and equal adverse-events in the drainage of pancreatic WON.
管腔对合金属支架（LAMS）越来越多地用于胰腺包裹性坏死（WON）的引流。支架的最佳选择存在争议，为此，关于LAMS和塑料支架（PS）的报道结果各不相同。我们对多个电子数据库和会议论文集进行了全面检索，包括PubMed、EMBASE和Web of Science数据库（从最早收录到2018年7月），以确定报告LAMS和PS用于WON引流的研究。自胰腺液体积聚的修订版亚特兰大分类发布以来（2014年至今）发表的研究纳入分析。结果是估计和比较临床成功率和不良事件的合并率。分析纳入了9项关于LAMS的研究（737例患者）和6项关于PS的研究（527例患者）。LAMS的临床成功率合并率为88.5%（95%CI 82.5 - 92.6，I² = 71.7），PS为88.1%（95%CI 80.5 - 93.0，I² = 78.1），差异无统计学意义，P = 0.93。在所有不良事件的合并率方面未发现差异，LAMS：11.2%（6.8 - 17.9，I² = 82.0）；PS：15.9%（8.4 - 27.8，I² = 78.8）；P = 0.38。基于我们的荟萃分析，在胰腺WON引流中，LAMS和PS显示出相同的临床结果和相同的不良事件。
