Giri Suprabhat, Harindranath Sidharth, Afzalpurkar Shivaraj, Angadi Sumaswi, Sundaram Sridhar
Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India.
Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India.
Ther Adv Gastrointest Endosc. 2023 Sep 19;16:26317745231199364. doi: 10.1177/26317745231199364. eCollection 2023 Jan-Dec.
Lumen apposing metal stents (LAMSs) have a higher clinical success rate for managing pancreatic fluid collections. But they are associated with adverse events (AEs) like bleeding, migration, buried stent, occlusion, and infection. It has been hypothesized that placing a double pigtail stent (DPS) within LAMS may mitigate these AEs. The present systematic review and meta-analysis were conducted to compare the outcome and AEs associated with LAMS with or without a coaxial DPS (LAMS-DPS).
A comprehensive literature search of three databases from January 2010 to August 2022 was conducted for studies comparing the outcome and AEs of LAMS alone and LAMS-DPS. Pooled incidence and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for all the dichotomous outcomes.
Overall, eight studies ( = 460) were included in the final analysis. The clinical success rate (RR 1.00, 95% CI: 0.87-1.14) and the risk of overall AEs (RR 1.60, 95% CI: 0.95-2.68) remained comparable between both groups. There was no difference in the risk of bleeding between LAMS alone and LAMS-DPS (RR 1.80, 95% CI: 0.83-3.88). Individual analysis of other AEs, including infection, stent migration, occlusion, and reintervention, showed no difference in the risk between both procedures.
The present meta-analysis shows that coaxial DPS within LAMS may not reduce AE rates or improve clinical outcomes. Further larger studies, including patients with walled-off necrosis, are required to demonstrate the benefit of coaxial DPS within LAMS.
管腔对合金属支架（LAMS）在处理胰液积聚方面具有较高的临床成功率。但它们与出血、移位、支架埋入、闭塞和感染等不良事件（AE）相关。有假设认为，在LAMS内放置双猪尾支架（DPS）可能会减轻这些不良事件。本系统评价和荟萃分析旨在比较使用或不使用同轴DPS（LAMS-DPS）的LAMS的结局和不良事件。
对2010年1月至2022年8月期间三个数据库进行全面文献检索，以查找比较单独使用LAMS和LAMS-DPS的结局和不良事件的研究。计算所有二分结局的合并发生率和风险比（RR）以及95%置信区间（CI）。
总体而言，最终分析纳入了八项研究（n = 460）。两组之间的临床成功率（RR 1.00，95%CI：0.87-1.14）和总体不良事件风险（RR 1.60，95%CI：0.95-2.68）仍然相当。单独使用LAMS和LAMS-DPS之间的出血风险没有差异（RR 1.80，95%CI：0.83-3.88）。对包括感染、支架移位、闭塞和再次干预在内的其他不良事件进行的个体分析显示，两种手术之间的风险没有差异。
本荟萃分析表明，LAMS内的同轴DPS可能不会降低不良事件发生率或改善临床结局。需要进一步开展更大规模的研究，包括纳入有包裹性坏死的患者，以证明LAMS内同轴DPS的益处。
