Harishankar Gopakumar, Vakya Revanur, Rajanikanth Kandula, Srinivas R Puli
{"title":"内镜超声引导下腔内金属支架与同轴塑料支架或不与同轴塑料支架治疗胰腺积液:安全性和有效性比较的系统综述和荟萃分析。","authors":"Harishankar Gopakumar, Vakya Revanur, Rajanikanth Kandula, Srinivas R Puli","doi":"10.20524/aog.2024.0858","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Endoscopic ultrasound (EUS)-guided lumen-apposing metal stents (LAMS) are preferred for draining symptomatic large pancreatic fluid collections (PFCs). A concurrent coaxial double-pigtail plastic stent (DPPS) is proposed to reduce adverse events associated with LAMS. We aimed to perform a comparative outcome analysis of LAMS with or without DPPS for PFCs.</p><p><strong>Methods: </strong>Electronic databases from January 2005 through July 2023 were searched for studies comparing the use of LAMS with or without DPPS for PFCs. Pooled proportions were calculated using fixed (inverse variance) and random-effects (DerSimonian-Laird) models.</p><p><strong>Results: </strong>After reviewing 1780 studies, we extracted data from 6 studies comprising 348 patients. The weighted odds of overall technical success, using LAMS plus DPPS compared to LAMS alone, were 0.53 (95% confidence interval [CI] 0.15-1.83), and the odds of clinical success were 1.10 (95%CI 0.59-2.05). The weighted odds of total adverse events with LAMS compared to LAMS plus DPPS were 2.21 (95%CI 1.37-3.59). Analysis of individual adverse events showed that the odds of stent occlusion when LAMS alone was used compared to LAMS plus DPPS was 2.36 (95%CI 1.12-4.98). The odds of bleeding were 1.84 (95%CI 0.77-4.38), and the odds of stent migration 0.95 (95%CI 0.40-2.23).</p><p><strong>Conclusions: </strong>EUS-guided LAMS placement is the current standard of care for managing symptomatic large PFCs. Concurrent use of coaxial DPPS can mitigate the overall adverse events observed with LAMS, while maintaining similar technical and clinical success.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 2","pages":"242-250"},"PeriodicalIF":2.1000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10927631/pdf/","citationCount":"0","resultStr":"{\"title\":\"Endoscopic ultrasound-guided lumen-apposing metal stent with or without coaxial plastic stent for pancreatic fluid collections: a systematic review and meta-analysis comparing safety and efficacy.\",\"authors\":\"Harishankar Gopakumar, Vakya Revanur, Rajanikanth Kandula, Srinivas R Puli\",\"doi\":\"10.20524/aog.2024.0858\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Endoscopic ultrasound (EUS)-guided lumen-apposing metal stents (LAMS) are preferred for draining symptomatic large pancreatic fluid collections (PFCs). A concurrent coaxial double-pigtail plastic stent (DPPS) is proposed to reduce adverse events associated with LAMS. We aimed to perform a comparative outcome analysis of LAMS with or without DPPS for PFCs.</p><p><strong>Methods: </strong>Electronic databases from January 2005 through July 2023 were searched for studies comparing the use of LAMS with or without DPPS for PFCs. Pooled proportions were calculated using fixed (inverse variance) and random-effects (DerSimonian-Laird) models.</p><p><strong>Results: </strong>After reviewing 1780 studies, we extracted data from 6 studies comprising 348 patients. The weighted odds of overall technical success, using LAMS plus DPPS compared to LAMS alone, were 0.53 (95% confidence interval [CI] 0.15-1.83), and the odds of clinical success were 1.10 (95%CI 0.59-2.05). The weighted odds of total adverse events with LAMS compared to LAMS plus DPPS were 2.21 (95%CI 1.37-3.59). Analysis of individual adverse events showed that the odds of stent occlusion when LAMS alone was used compared to LAMS plus DPPS was 2.36 (95%CI 1.12-4.98). The odds of bleeding were 1.84 (95%CI 0.77-4.38), and the odds of stent migration 0.95 (95%CI 0.40-2.23).</p><p><strong>Conclusions: </strong>EUS-guided LAMS placement is the current standard of care for managing symptomatic large PFCs. Concurrent use of coaxial DPPS can mitigate the overall adverse events observed with LAMS, while maintaining similar technical and clinical success.</p>\",\"PeriodicalId\":7978,\"journal\":{\"name\":\"Annals of Gastroenterology\",\"volume\":\"37 2\",\"pages\":\"242-250\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10927631/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Gastroenterology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.20524/aog.2024.0858\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/2/12 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Gastroenterology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.20524/aog.2024.0858","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/2/12 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Endoscopic ultrasound-guided lumen-apposing metal stent with or without coaxial plastic stent for pancreatic fluid collections: a systematic review and meta-analysis comparing safety and efficacy.
Background: Endoscopic ultrasound (EUS)-guided lumen-apposing metal stents (LAMS) are preferred for draining symptomatic large pancreatic fluid collections (PFCs). A concurrent coaxial double-pigtail plastic stent (DPPS) is proposed to reduce adverse events associated with LAMS. We aimed to perform a comparative outcome analysis of LAMS with or without DPPS for PFCs.
Methods: Electronic databases from January 2005 through July 2023 were searched for studies comparing the use of LAMS with or without DPPS for PFCs. Pooled proportions were calculated using fixed (inverse variance) and random-effects (DerSimonian-Laird) models.
Results: After reviewing 1780 studies, we extracted data from 6 studies comprising 348 patients. The weighted odds of overall technical success, using LAMS plus DPPS compared to LAMS alone, were 0.53 (95% confidence interval [CI] 0.15-1.83), and the odds of clinical success were 1.10 (95%CI 0.59-2.05). The weighted odds of total adverse events with LAMS compared to LAMS plus DPPS were 2.21 (95%CI 1.37-3.59). Analysis of individual adverse events showed that the odds of stent occlusion when LAMS alone was used compared to LAMS plus DPPS was 2.36 (95%CI 1.12-4.98). The odds of bleeding were 1.84 (95%CI 0.77-4.38), and the odds of stent migration 0.95 (95%CI 0.40-2.23).
Conclusions: EUS-guided LAMS placement is the current standard of care for managing symptomatic large PFCs. Concurrent use of coaxial DPPS can mitigate the overall adverse events observed with LAMS, while maintaining similar technical and clinical success.