Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website https://www.gastrores.org

Original Article

Volume 16, Number 2, April 2023, pages 59-67

Lumen-Apposing Metal Stent With and Without Concurrent Double-Pigtail Plastic Stent for Pancreatic Fluid Collections: A Comparative Systematic Review and Meta-Analysis

Figures

Figure 1.
Figure 1. PRISMA flow diagram of included studies. PRISMA: preferred reporting items for systematic reviews and meta-analyses; DPPS: double-pigtail plastic stent; LAMS: lumen-apposing metal stent.
Figure 2.
Figure 2. Forest plots comparing between LAMS plus DPPS and LAMS alone for drainage of pancreatic fluid collections regarding: (a) technical success and (b) clinical success. DPPS: double-pigtail plastic stent; LAMS: lumen-apposing metal stent; CI: confidence interval.
Figure 3.
Figure 3. Forest plots comparing between LAMS plus DPPS and LAMS alone for drainage of pancreatic fluid collections regarding: (a) overall adverse events, (b) stent migration, and (c) stent occlusion. DPPS: double-pigtail plastic stent; LAMS: lumen-apposing metal stent; CI: confidence interval.
Figure 4.
Figure 4. Forest plots comparing between LAMS plus DPPS and LAMS alone for drainage of pancreatic fluid collections regarding: (a) bleeding, (b) infection, and (c) perforation. DPPS: double-pigtail plastic stent; LAMS: lumen-apposing metal stent; CI: confidence interval.

Tables

Table 1. Study Characteristics of the Included Studies
 
Study characteristicsAburajab et al, 2018 [18]Ali et al, 2019 [21]Haddad et al, 2022 [20]Puga et al, 2018 [17]Shamah et al, 2022 [19]
DPPS: double-pigtail plastic stent; LAMS: lumen-apposing metal stent; NR: not reported; PFC: pancreatic fluid collection; SD: standard deviation.
Study designRetrospective cohort, single-centerRetrospective cohort, single-centerRetrospective cohort, single-centerRetrospective cohort, single-centerRetrospective cohort, multi-center
Country of originUSAUSAUSASpainUSA
Total number (LAMS/LAMS + DPPS)47 (24/23)57 (21/36)68 (45/23)41 (21/20)68 (33/35)
Male, n (%)35 (74.5%)34 (60%)36 (53%)32 (78%)44 (65%)
Age (years), mean ± SD50.6 ± 12.1NR46.5 ± 16.258.7 ± 14.154.8 ± 13.2
PFC size (cm), mean ± SD (LAMS/LAMS + DPPS)9.5 ± 4 (10 ± 4/9 ± 4)(9/10.5)14.7 ± 5.9 (15 ± 5.7/14.2 ± 6.2)9.6 ± 1.3 (10 ± 1.06/9.1 ± 1.3)10.9 ± 3.8 (11.4 ± 4/10.37 ± 3.5)
LAMS size15 mm10 or 15 mm15, 10, and 20 mm10 or 15 mm10 or 15 mm
Number of necrosectomies, mean (LAMS/LAMS/DPPS)NRNR1.14/1.56NRNR
Stent duration, median (weeks), (LAMS/LAMS + DPPS)NRNR7.38/7.86NRNR
Outcomes reportedTechnical success, clinical success, overall adverse events, stent migration, bleeding, infection, and perforationTechnical success, clinical success, overall adverse events, stent migration, stent occlusion, bleeding, and infectionTechnical success, clinical success, overall adverse events, stent migration, stent occlusion, bleeding, and infectionTechnical success, clinical success, overall adverse events, stent migration, bleeding, and infectionTechnical success, clinical success, overall adverse events, stent migration, stent occlusion, bleeding, and perforation
Clinical success definitionSymptom improvement with resolution of PFC on imaging to < 2 cm and without further interventionSymptom improvement with resolution of PFC on imaging to < 2 cm without further interventionSymptom resolution or PFC resolution on imagingDecrease in PFC size by at least 50% on imaging at 4 - 6 weeks’ follow-up with symptom resolutionSymptom resolution and complete resolution of PFC on imaging at 3-month follow-up
Follow-up durationNRNR189 daysNR90 days

 

Table 2. Baseline Patients and Procedural Characteristics Included in the Meta-Analysis
 
Number of studiesAll patients (n = 281)LAMS (n = 144)LAMS + DPPS (n = 137)P value
DPPS: double-pigtail plastic stent; LAMS: lumen-apposing metal stent; NS: not significant; PFC: pancreatic fluid collection; PP: pancreatic pseudocyst; PPI: proton pump inhibitor; SD: standard deviation; WOPN: walled-off pancreatic necrosis.
Age, year452.1 ± 14.751 ± 13.853.5 ± 15.8NS (0.21)
Male gender564.4% (181/281)65% (78/120)68.4% (78/114)NS (0.58)
PPI use249% (51/104)% (25/45)44.1% (26/59)NS (0.24)
PFC size, cm (mean ± SD)411.5 ± 4.812.2 ± 4.910.7 ± 4.50.02
PFC type5
  PP51.2% (144/281)47.5% (57/120)35.1% (40/114)NS (0.06)
  WOPN44.5% (125/281)50% (60/120)57% (65/114)NS (0.28)
PFC etiology4
  Alcohol31% (74/240)30% (37/123)31.6% (37/117)NS (0.79)
  Gallstones33% (79/240)38.2% (47/123)27.4% (32/117)NS (0.08)
PFC location4
  Head10% (23/224)8% (10/123)13% (13/101)NS (0.25)
  Body60% (134/224)62% (76/123)57% (58/101)NS (0.51)
  Tail18% (40/224)18% (22/123)18% (18/101)NS (0.99)
Drainage site4
  Transgastric85% (181/213)89% (88/99)82% (93/114)NS (0.13)
  Transduodenal11% (24/213)10% (10/99)12% (14/114)NS (0.62)