Comparison Between Lumen-Apposing Metal Stents and Plastic Stents in Endoscopic Ultrasound–Guided Drainage of Pancreatic Fluid Collection

Abstract

Objectives: This study aimed to explore efficacy and safety between LAMSs (lumen-apposing metal stents) and DPPSs (double-pigtail plastic stents) in endoscopic ultrasound-guided drainage for pancreatic fluid collections.Methods: Electronic databases were searched to identify relevant studies published until July 20, 2020.Results: Fifteen studies were identified in this study. Endoscopic ultrasoundguided drainage with LAMS has higher clinical success (90.01% vs 82.56%) (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.79-3.33; P < 0.00001), less recurrence (OR, 0.44; 95% CI, 0.29-0.68; P = 0.0002), and fewer additional interventions (OR, 0.34; 95% CI, 0.211-0.55; P < 0.001). There was no significant difference between LAMS and DPPS in technical success (97.45% vs 97.38%) (OR, 0.92; 95% CI, 0.50-1.70; P = 0.80), adverse events (OR, 0.92; 95% CI, 0.41-2.09; P = 0.84), stent-related adverse events (OR, 0.78; 95% CI, 0.39-1.54; P = 0.47), and bleeding (OR, 1.47; 95% CI, 0.57-3.28; P = 0.42). Lumen-apposing metal stents have slightly more perforations (OR, 7.10; 95% CI, 1.22-41.30; P = 0.03) in studies of walled-off necrosis.Conclusions: Lumen-apposing metal stents have the advantage of higher clinical success, less recurrence, and fewer additional interventions. However, LAMS may increase perforation for walled-off necrosis.

EUS-guided drainage of large walled-off pancreatic necroses using plastic versus lumen-apposing metal stents: a single-centre randomised controlled trial

“…When comparing DPT and LAMS for transluminal access to WON, a recent meta-analysis found LAMS to be significantly more clinically successful 20. However, the only randomised study published until now, by Bang et al , did not find any difference between DPT and LAMS when comparing key parameters, such as clinical success, LOS or mortality 11.…”

Adverse events associated with AXIOS stents

“…These included but not limited to biliary drainage (EUS-guided choledochoduodenostomy and EUS-guided cholecystostomy), luminal bypass (EUS-guided gastroenterostomy), EUS-guided transmural drainage of PFCs (including walled off necrosis and pseudocysts), and for treatment of postsurgical fluid collections. [ 13 14 15 16 17 18 ] Table 5 shows a summary of these indications and their rates technical and clinical success as well as adverse events. Overall, AXIOS stent placement has been associated with high clinical and technical success with adverse events ranging from 4% to 22%, depending on the indication.…”

Controversies in EUS-guided treatment of walled-off necrosis

“…In conclusion, lumen-apposing stents seem to be preferable to plastic stents, but to date, there are no solid data in the literature to confirm this endoscopists’ choice. [ 68 69 70 ]…”