Early versus delayed removal of lumen apposing metal stent after cystogastrostomy: a systematic review and meta-analysis.

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2025-09-14 DOI:10.1016/j.pan.2025.09.016

Anshuman Elhence, Prabhaker Mishra, Praveer Rai

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引用次数: 0

Abstract

Background: Lumen apposing metal stents (LAMS) for cystogastrostomy are preferred in view of a quicker procedure and wider port for drainage in patients with pancraetic fluid collections. However, late removal of LAMS beyond 4 weeks is thought to be associated with complications such as bleeding. We aimed to synthesize data from studies comparing early (≤4 weeks) versus delayed removal of LAMS.

Methods: A comprehensive literature review of three major databases (Medline, Embase and Scopus) was done for articles comparing outcomes of early versus late removal of LAMS. The relative risk (RR) of adverse events was pooled using inverse variance weighting and random effects meta-analysis. The quality of studies was assessed using Newcastle Ottawa scale (NOS) and the publication bias was assessed with a funnel-plot. The protocol was registered on PROSPERO (CRD420251022113).

Results: Literature search of three databases showed 982 articles of which 4 were selected as per the inclusion criteria. All the studies scored ≥7 on the NOS. There was no publication bias (Egger's test p = 0.53). The random effects model showed a pooled RR of adverse events of 1.13 (95 % confidence interval (CI) 0.59 to 2.17, I² = 38 %) in the delayed-removal group. The RR of bleeding was 1.41 (95 % CI 0.23 to 8.80, I² = 35 %) in the delayed removal group as compared to the early removal group. Leave-out-one sensitivity analysis confirmed the robustness of results.

Conclusions: Delayed removal of LAMS even beyond 4 weeks may not be associated with an increased risk of complications. The timing of removal should be guided by radiologic and clinical responses.

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膀胱胃造口术后早期与延迟取腔金属支架：系统回顾和荟萃分析

背景：腔内金属支架（LAMS）用于膀胱胃造口术，由于其手术过程更快，引流口更宽，对于胰液收集的患者是首选。然而，超过4周的LAMS切除被认为与出血等并发症有关。我们的目的是综合比较早期（≤4周）和延迟切除LAMS的研究数据。方法：对三个主要数据库（Medline， Embase和Scopus）进行全面的文献综述，比较早期和晚期切除LAMS的结果。不良事件的相对风险（RR）采用反方差加权和随机效应荟萃分析进行汇总。研究质量采用纽卡斯尔渥太华量表（NOS）评估，发表偏倚采用漏斗图评估。该协议在PROSPERO上注册（CRD420251022113）。结果：3个数据库共检索文献982篇，按纳入标准筛选出4篇。所有研究的NOS评分均≥7分，无发表偏倚（Egger’s检验p = 0.53）。随机效应模型显示，延迟切除组不良事件的合并RR为1.13（95%可信区间（CI） 0.59 ~ 2.17, I2 = 38%）。与早期切除组相比，延迟切除组出血的RR为1.41 （95% CI 0.23 ~ 8.80, I2 = 35%）。遗漏1的敏感性分析证实了结果的稳健性。结论：延迟切除LAMS甚至超过4周可能不会增加并发症的风险。切除的时机应以放射学和临床反应为指导。

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

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.