Does a coaxial double pigtail stent reduce adverse events after lumen apposing metal stent placement for pancreatic fluid collections? A systematic review and meta-analysis

Abstract

Background: Lumen apposing metal stents (LAMSs) have a higher clinical success rate for managing pancreatic fluid collections. But they are associated with adverse events (AEs) like bleeding, migration, buried stent, occlusion, and infection. It has been hypothesized that placing a double pigtail stent (DPS) within LAMS may mitigate these AEs. The present systematic review and meta-analysis were conducted to compare the outcome and AEs associated with LAMS with or without a coaxial DPS (LAMS-DPS). Methods: A comprehensive literature search of three databases from January 2010 to August 2022 was conducted for studies comparing the outcome and AEs of LAMS alone and LAMS-DPS. Pooled incidence and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for all the dichotomous outcomes. Results: Overall, eight studies ( n = 460) were included in the final analysis. The clinical success rate (RR 1.00, 95% CI: 0.87–1.14) and the risk of overall AEs (RR 1.60, 95% CI: 0.95–2.68) remained comparable between both groups. There was no difference in the risk of bleeding between LAMS alone and LAMS-DPS (RR 1.80, 95% CI: 0.83–3.88). Individual analysis of other AEs, including infection, stent migration, occlusion, and reintervention, showed no difference in the risk between both procedures. Conclusion: The present meta-analysis shows that coaxial DPS within LAMS may not reduce AE rates or improve clinical outcomes. Further larger studies, including patients with walled-off necrosis, are required to demonstrate the benefit of coaxial DPS within LAMS.

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

“…Furthermore, no adverse events were attributed to the additional use of DPPS in this setting. Previous studies, including meta-analyses by Beran et al and Giri et al , were inconclusive, but demonstrated a trend favoring this approach [ 25 , 26 ]. Our findings suggest that there is a benefit.…”

“…Placement of a concurrent coaxial DPPS through the LAMS has been proposed as a method to reduce LAMS-related adverse events by improving patency, anchoring the LAMS in the intended position, and reducing its impact on adjacent vasculature [ 18 ]. Studies evaluating the safety and efficacy of this approach have shown conflicting or inconclusive results, and there is still no consensus on whether this should be standard practice [ 19 - 26 ]. With the availability of new data, including from a well-designed randomized controlled trial (RCT), we decided to conduct this systematic review and meta-analysis.…”

Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: Not All Queries Are Already Solved

“…A meta-analysis by Giri et al [58] analyzed eight studies from 2010 and 2022 and showed that, although the overall AE rate was lower in the LAMS-DPPS group, the results were not statistically significant, and the effort and cost that is involved in the placement of an additional coaxial stent do not translate to better clinical outcomes. Furthermore, these results conflict with those of the first randomized controlled trial by Vanek et al [59], including 67 patients randomly assigned to LAMS placement with (n = 34) or without (n = 33) DPPS.…”

Comparative outcome of single versus two double-pigtail stents for endoscopic drainage of pancreatic fluid collections with minimal necrosis: a retrospective analysis

“…Endoscopic drainage is preferred over surgical and percutaneous drainage as it establishes internal drainage without the morbidity associated with surgery (1). The choice of a stent for endoscopic management depends on the type of PFC (2), with metal stents being preferred for WON and plastic stents for pseudocysts (3). In a previous meta-analysis, metal stents were associated with a higher clinical success rate than plastic stents in WON and pseudocyst (4).…”