Li Jing, Zhang Qian, Zhou Anni, Zhao Guiping, Li Peng
Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100050, China.
Chronic Dis Transl Med. 2021 Aug 11;7(3):157-168. doi: 10.1016/j.cdtm.2021.07.001. eCollection 2021 Sep.
Endoscopic ultrasound (EUS)-guided transmural drainage for pancreatic fluid collections (PFCs) has become the first-line treatment with quicker recovery and more minor injury compared with surgery and percutaneous drainage. The efficacy of stents implantation and drainage for different PFCs remains controversial, especially lumen-apposing metal stents (LAMS). This study aimed to compare the efficacy and safety of LAMS drainage for pancreatic pseudocysts (PPC) and walled-off necrosis (WON).
A meta-analysis was performed for LAMS drainage for WON and PPC by systematically searching PubMed, Cochrane, and Embase databases from January 2010 to January 2020. From 2017 to 2019, 12 patients who were treated with LAMS drainage for PFCs in our medical center were also reviewed and included in this study.
Combining 11 copies of documents with the data from our medical center, a total of 585 patients with PFCs were enrolled in this meta-analysis, including 343 patients with WON and 242 with PPC. The technical success rate in WON is not significantly different from that of PPC ( = 0.08 > 0.05). The clinical success of LAMS placement was achieved in 99% vs 89% in PPC and WON, respectively (RR = 0.92, 95% CI: 0.86-0.98, = 0.01 < 0.05). The further intervention of direct endoscopic necrosectomy was required by 60% of patients in WON group. There was no significant difference in the incidence of adverse events, including infection, bleeding, stent migration and stent occlusion, after LAMS placement between WON and PPC.
Endoscopic ultrasound-guided LAMS for PFCs are feasible, effective with preferable technical and clinical success rates. The clinical effect of LAMS on PPC is slightly better than that of WON, but its adverse reactions still need to be verified in a large-sample prospective study.
与手术和经皮引流相比，内镜超声（EUS）引导下经壁引流胰腺液体积聚（PFC）已成为一线治疗方法，具有恢复更快、损伤更小的优点。支架植入和引流对不同类型PFC的疗效仍存在争议，尤其是管腔贴壁金属支架（LAMS）。本研究旨在比较LAMS引流胰腺假性囊肿（PPC）和包裹性坏死（WON）的疗效和安全性。
通过系统检索2010年1月至2020年1月的PubMed、Cochrane和Embase数据库，对WON和PPC的LAMS引流进行荟萃分析。2017年至2019年，对我院医疗中心12例接受LAMS引流治疗PFC的患者进行回顾并纳入本研究。
结合11份文献和我院医疗中心的数据，本荟萃分析共纳入585例PFC患者，其中WON患者343例，PPC患者242例。WON的技术成功率与PPC无显著差异（P = 0.08 > 0.05）。PPC和WON中LAMS置入的临床成功率分别为99%和89%（RR = 0.92，95%CI：0.86 - 0.98，P = 0.01 < 0.05）。WON组60%的患者需要进一步进行直接内镜坏死组织切除术干预。WON和PPC在LAMS置入后不良事件（包括感染、出血、支架移位和支架闭塞）的发生率无显著差异。
内镜超声引导下LAMS治疗PFC可行、有效，技术和临床成功率较好。LAMS对PPC的临床效果略优于WON，但其不良反应仍需在大样本前瞻性研究中得到验证。
