Comparative outcome of metal versus plastic stents for the management of walled-off pancreatic necrosis - An updated meta-analysis of randomised studies.

Objective: The choice of the stent for managing walled-off pancreatic necrosis (WOPN) is a topic of debate with varying reported outcomes between metal and plastic stents. The present meta-analysis aimed to compare the efficacy and safety of metal and plastic stents for the drainage of WOPN.

Patients and methods: A comprehensive search of literature from inception to December 2024 was done on three databases for randomised controlled trials comparing metal and plastic stents for drainage of WOPN. Risk ratios with 95% confidence intervals (CIs) were calculated for all the dichotomous outcomes. Continuous variables were analysed using mean difference (MD).

Results: A total of 821 records were identified, of which seven studies were included in the final analysis. The procedural duration was significantly lower with metal stents with an MD of-11.32 min (95% CI: -17.75--4.88). However, there was no difference between the two groups in terms of stent-related periprocedural adverse events, bleeding, serious bleeding, treatment success, need for necrosectomy, number of necrosectomies, number of reinterventions, need for percutaneous drainage, need for surgery, duration of hospitalisation, mortality, stent dysfunction, recurrence of WOPN, endocrine and exocrine insufficiency. The procedural costs were significantly higher for metal compared with plastic stents (MD 2.4 × 103 $, 95% CI: 1.2-3.7), with no significant difference in the overall cost.

Conclusion: Except for a significantly shorter procedural duration, metal stents do not offer any significant advantage over plastic stents for WOPN drainage. Further studies are required before routinely recommending metal stents for WOPN drainage.