Endoscopic Ultrasound‐guided Drainage With Lumen‐apposing Metal Stent versus Plastic Stent for the Treatment of Pancreatic Pseudocyst: A Systematic Review and Meta‐analysis

TL;DR

This study compares two drainage methods for pancreatic pseudocysts and finds that metal stents offer better success rates and faster procedures than plastic stents.

Contribution

The study provides a meta-analysis comparing lumen-apposing metal stents and plastic stents for endoscopic ultrasound-guided drainage of pancreatic pseudocysts.

Findings

Lumen-apposing metal stents (LAMS) showed higher clinical success rates than plastic stents.

LAMS reduced procedure time compared to plastic stents.

No significant differences were found in adverse events, recurrence, or technical success between the two methods.

Abstract

Pancreatic pseudocyst (PP), following acute or chronic pancreatitis, may become symptomatic or persist beyond 6–8 weeks, requiring drainage. Endoscopic ultrasonography‐guided drainage (EUS‐D) is the preferred method, using double pigtail plastic stents (DPPS) or self‐expandable metallic stents (SEMS), such as lumen‐apposing metal stents (LAMS). This meta‐analysis compares DPPS and LAMS in EUS‐D for PP, focusing on technical success, clinical success, adverse events (AEs), recurrence, and procedure time.

A search strategy was conducted in MEDLINE, Embase, Lilacs, and Cochrane databases according to PRISMA guidelines. Random‐effect models were used for statistical analysis based on intention‐to‐treat. Heterogeneity was assessed using the I2 test. The risk of bias was assessed using the Risk of Bias in Non‐randomized Studies—of Exposures tool. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation Tool.

Ten studies were included: one prospective cohort and nine retrospective cohorts, conducted between 2014 and 2024. A total of 502 patients with PP were treated with EUS‐D. The clinical success rate was higher using LAMS (Risk ratio [RR] = 1.05; 95% confidence interval [CI]: 1.01; 1.09; I2 = 0%), with shorter procedure time (Mean difference = ‐16.30; 95% CI: ‐27.65; ‐4.94; I2 = 86%) compared to DPPS. No statistical difference was observed for early and late AEs, recurrence, or technical success.

The study demonstrated that LAMS has a higher clinical success rate and a shorter procedure time compared to DPPS. There is no difference in terms of early and late AEs, recurrence, and technical success.

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