Metal versus plastic stents for EUS-guided walled-off necrosis drainage: a systematic review and meta-analysis of randomized controlled trials.

IF 2.7 2区医学 Q2 SURGERY

Surgical Endoscopy And Other Interventional Techniques Pub Date : 2025-05-01 Epub Date: 2025-03-17 DOI:10.1007/s00464-025-11665-w

Omar Saab, Hasan Al-Obaidi, Marwah Algodi, Asma Algodi, Yasir Rashid, Alhareth Al-Sagban, Nooraldin Merza, Mohamed Abuelazm, Layth Alzubaidy, Muhammad Usman Baig, Reem Sharaiha

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引用次数: 0

Abstract

Background & objective: The endoscopic step-up approach is the mainstay of walled-off necrosis management (WON). However, using metal stents versus plastic stents during WON drainage is debatable, with limited high-quality evidence. Therefore, we aim to investigate the comparative safety and efficacy of metal versus plastic stents for endoscopic ultrasound (EUS) guided WON drainage.

Methods: A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), retrieved by systematically searching PubMed, EMBASE, WOS, SCOPUS, and Cochrane through July 2024. Continuous and dichotomous outcome variables were pooled using mean difference (MD) and risk ratio (RR), with confidence interval (CI) using Stata MP v. 17. We assessed heterogeneity using the chi-square test and I² statistic.

Prospero id: CRD42024573859.

Results: Six RCTs with 352 patients were included. There was no difference between both groups regarding clinical success (RR: 1.04 with 95% CI [0.88-1.23], p = 0.61), WON recurrence (RR: 1.46 with 95% CI [0.59-3.61], p = 0.41), the need of necrosectomy (RR: 0.96 with 95% CI [0.65-1.41], p = 0.84), the total number of necrosectomy sessions (MD: 1.03 with 95% CI [- 0.33, 2.40], p = 0.14), total number of interventions (MD: - 0.09 with 95% CI [- 0.72, 0.54], p = 0.79), mortality (RR: 0.87 with 95% CI [0.32-2.37], p = 0.79), bleeding (RR: 1.35 with 95% CI [0.58-3.12], p = 0.48), and stent migration (RR: 0.69 with 95% CI [0.28-1.71], p = 0.42). However, metal stents significantly decreased the procedure duration (MD: - 11.27 with 95% CI [- 17.69, - 4.86], p < 0.001).

Conclusion: There was no significant difference between metal and plastic stents in efficacy and safety outcomes during WON EUS-guided drainage, except for a shorter procedural duration with metal stents.

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金属支架与塑料支架在eus引导下封闭坏死引流中的对比：随机对照试验的系统回顾和荟萃分析。

背景与目的：内窥镜升级入路是隔离性坏死治疗（WON）的主要方法。然而，在WON引流中使用金属支架还是塑料支架是有争议的，缺乏高质量的证据。因此，我们的目的是研究金属支架与塑料支架在超声内镜（EUS）引导下进行WON引流的安全性和有效性。方法：通过系统检索PubMed、EMBASE、WOS、SCOPUS和Cochrane，对截至2024年7月的随机对照试验（RCTs）进行系统评价和荟萃分析。使用平均差（MD）和风险比（RR）合并连续和二分类结果变量，使用Stata MP v. 17合并置信区间（CI）。我们使用卡方检验和I2统计量评估异质性。普洛斯彼罗id: CRD42024573859。结果：纳入6项随机对照试验，共352例患者。两组之间没有差别关于临床成功(RR: 1.04, 95%置信区间[0.88 - -1.23],p = 0.61),赢得了复发(RR: 1.46, 95%置信区间[0.59 - -3.61],p = 0.41),需要进行(RR: 0.96, 95%置信区间[0.65 - -1.41],p = 0.84),进行会话的总数(MD: 1.03, 95%可信区间(- 0.33,2.40),p = 0.14),干预措施的总数(MD: - 0.09和95%可信区间(- 0.72,0.54),p = 0.79),死亡率(RR: 0.87, 95%置信区间[0.32 - -2.37],p = 0.79),出血(RR:1.35, 95% CI [0.58-3.12], p = 0.48)和支架迁移（RR: 0.69, 95% CI [0.28-1.71], p = 0.42）。然而，金属支架明显缩短了手术时间（MD: - 11.27, 95% CI [- 17.69, - 4.86]）， p结论：金属支架与塑料支架在WON eus引导下引流的疗效和安全性方面无显著差异，金属支架的手术时间更短。

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 Endoscopy And Other Interventional Techniques 医学-外科

CiteScore

6.10

自引率

12.90%

发文量

890

审稿时长

6 months

期刊介绍： Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research. Topics covered in the journal include: -Surgical aspects of: Interventional endoscopy, Ultrasound, Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology, -Gastroenterologic surgery -Thoracic surgery -Traumatic surgery -Orthopedic surgery -Pediatric surgery