Zafar Yousaf, Sohail Muhammad Umer, Ibrahim Zainab Siddiqua, Batool Ruqiat Masooma, Ansari Ifrah, Ahmed Syed Zaeem, Saad Muhammad, Aisha Eliza, Waqas Saad Ahmed, Sohail Muhammad Ovais, Bukeirat Faisal, Tang Shou Jiang, Ahmed Raheel
Department of Internal Medicine University of Mississippi Medical Center Jackson USA.
Department of Medicine Dow University of Health Sciences Karachi Pakistan.
JGH Open. 2025 Feb 3;9(2):e70109. doi: 10.1002/jgh3.70109. eCollection 2025 Feb.
Walled-off necrosis (WON) is a potentially fatal condition best treated endoscopically with metal or plastic stents. This study compares the clinical outcomes of these stents.
PubMed and Cochrane were searched for trials comparing metal and plastic stents for WON. Primary outcomes were clinical and technical success.
Seven studies with 230 metal stent patients and 226 plastic stent patients were included. Metal stents showed significantly shorter procedure times (SMD -0.80, 95% CI: -1.25 to -0.34), better 4-week clinical success (OR 1.94, 95% CI: 1.00 to 3.77), and higher procedure costs (SMD 1.38, 95% CI: 0.56 to 2.20). No significant differences were observed in hospital stay (SMD -0.05, 95% CI: -0.35 to 0.25), technical success (OR 1.45, 95% CI: 0.22 to 9.43), clinical success (OR 1.13, 95% CI: 0.54 to 2.39), interventions (SMD -0.02, 95% CI: -0.34 to 0.29), need for necrosectomy (RR 1.10, 95% CI: 0.59 to 2.04), necrosectomy sessions (SMD 0.35, 95% CI: -0.42 to 1.11), need for percutaneous drainage (RR 0.82, 95% CI: 0.36 to 1.85), stent migration (RR 0.88, 95% CI: 0.29 to 2.66), bleeding (RR 0.97, 95% CI: 0.53 to 1.75), WON recurrence (RR 1.66, 95% CI: 0.70 to 3.92), treatment failure (death) (RR 0.75, 95% CI: 0.37 to 1.53), disconnected pancreatic duct (RR 0.93, 95% CI: 0.79 to 1.11), and total cost (SMD -0.02, 95% CI: -0.29 to 0.26).
Metal stents offer shorter procedure time and better 4-week clinical success, although at a higher cost, with most clinical outcomes showing no significant differences between stent types.
包裹性坏死（WON）是一种潜在致命性疾病，最佳治疗方法是通过金属或塑料支架进行内镜治疗。本研究比较了这些支架的临床疗效。
检索PubMed和Cochrane数据库，查找比较金属支架和塑料支架治疗WON的试验。主要结局指标为临床成功率和技术成功率。
纳入7项研究，其中230例患者使用金属支架，226例患者使用塑料支架。金属支架的手术时间显著更短（标准化均数差-0.80，95%可信区间：-1.25至-0.34），4周时的临床成功率更高（比值比1.94，95%可信区间：1.00至3.77），且手术成本更高（标准化均数差1.38，95%可信区间：0.56至2.20）。在住院时间（标准化均数差-0.05，95%可信区间：-0.35至0.25）、技术成功率（比值比1.45，95%可信区间：0.22至9.43）、临床成功率（比值比1.13，95%可信区间：0.54至2.39）、干预措施（标准化均数差-0.02，95%可信区间：-0.34至0.29）、坏死组织清除术需求（相对危险度1.10，95%可信区间：0.59至2.04）、坏死组织清除术次数（标准化均数差0.35，95%可信区间：-0.42至1.11）、经皮引流需求（相对危险度0.82，95%可信区间：0.36至1.85）、支架移位（相对危险度0.88，95%可信区间：0.29至2.66）、出血（相对危险度0.97，95%可信区间：0.53至1.75）、WON复发（相对危险度1.66，95%可信区间：0.70至3.92）、治疗失败（死亡）（相对危险度0.75，95%可信区间：0.37至1.53）、胰管离断（相对危险度0.93，95%可信区间：0.79至1.11）以及总成本（标准化均数差-0.02，95%可信区间：-0.29至0.26）方面，未观察到显著差异。
金属支架手术时间更短，4周时临床成功率更高，尽管成本更高，但大多数临床结局显示不同类型支架之间无显著差异。
