Fully Covered Self-expandable Metallic Stents for Refractory Benign Pancreatic Duct Strictures: A Systematic Review and Meta-analysis.

IF 1.1 4区医学 Q3 SURGERY

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques Pub Date : 2024-10-01 DOI:10.1097/SLE.0000000000001315

Gajanan Rodge, Suprabhat Giri, Kailash Kolhe, Shivaraj Afzalpurkar, Sidharth Harindranath, Sridhar Sundaram, Aditya Kale

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引用次数: 0

Abstract

Background: Endoscopic treatment of refractory pancreatic duct (PD) strictures includes the placement of multiple plastic stents. Recent studies have shown the benefit of fully covered self-expandable metal stents (FCSEMS). This systematic review analyzes the efficacy and safety of FCSEMS in PD strictures.

Methods: A comprehensive search of all suitable studies was conducted using the databases of MEDLINE, EMBASE, and Scopus from inception to November 2022. The outcomes assessed were efficacy and safety of FCSEMS in PD strictures. Using a random-effects inverse-variance model, the pooled proportions were calculated.

Results: A total of 22 studies with 439 patients were included in the analysis. The pooled stricture resolution rate was 91.6% (95% CI: 87.4-95.7), while the pooled pain resolution rate was 84.9% (95% CI: 77.7-92.1). The pooled incidences of stent-related adverse events, including acute pancreatitis, pain requiring stent removal, and de novo stricture, were 3.9% (95% CI: 1.2-6.7), 0.8% (95% CI: 0.0-2.1), and 3.3% (95% CI: 0.7-5.8). The pooled incidence of stent migration, stricture recurrence, and the need for restenting were 12.9% (95% CI: 6.7-19.1), 9.3% (95% CI: 4.7-13.8), and 12.3% (95% CI: 6.9-17.8), respectively.

Conclusions: FCSEMSs can be considered in carefully selected patients with benign PD strictures with high resolution rate and acceptable adverse event rate. De-novo structure formation appears to be a significant problem. Further studies may help to decide the role of FCSEMS in the algorithm.

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治疗难治性良性胰管狭窄的全覆盖自扩张金属支架：系统综述与元分析》。

背景：难治性胰管（PD）狭窄的内窥镜治疗包括放置多个塑料支架。最近的研究显示了全覆盖自膨胀金属支架（FCSEMS）的益处。本系统综述分析了 FCSEMS 对 PD 狭窄的疗效和安全性：方法：使用 MEDLINE、EMBASE 和 Scopus 数据库对从开始到 2022 年 11 月的所有合适研究进行了全面检索。评估的结果是FCSEMS治疗PD狭窄的有效性和安全性。采用随机效应逆方差模型计算汇总比例：结果：共有 22 项研究、439 名患者被纳入分析。总的狭窄缓解率为 91.6%（95% CI：87.4-95.7），总的疼痛缓解率为 84.9%（95% CI：77.7-92.1）。支架相关不良事件（包括急性胰腺炎、需要移除支架的疼痛和新发狭窄）的汇总发生率分别为 3.9% （95% CI：1.2-6.7）、0.8% （95% CI：0.0-2.1）和 3.3% （95% CI：0.7-5.8）。支架移位、狭窄复发和需要重新植入的总发生率分别为12.9%（95% CI：6.7-19.1）、9.3%（95% CI：4.7-13.8）和12.3%（95% CI：6.9-17.8）：对于经过严格筛选的良性腹腔肠系膜狭窄患者，可以考虑使用 FCSEMS，其症状缓解率高，不良反应率可接受。新结构的形成似乎是一个重要问题。进一步的研究可能有助于确定 FCSEMS 在算法中的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 医学-外科

CiteScore

2.00

自引率

10.00%

发文量

103

审稿时长

3-8 weeks

期刊介绍： Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.