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20-03-2024 | Review Article

Efficacy and safety of long-term indwelling plastic stents after resolution of pancreatic fluid collections with endoscopic transmural drainage: a systematic review and meta-analysis

Authors: Fadi Hawa, Jean M. Chalhoub, Ana Vilela, Elit Quingalahua, Carol Shannon, George M. Philips, Richard S. Kwon, Erik-Jan Wamsteker, Allison R. Schulman, Matthew J. DiMagno, Jorge D. Machicado

Published in: Surgical Endoscopy | Issue 5/2024

Abstract

Background

Pancreatic fluid collections (PFCs) may recur after resolution with endoscopic transmural drainage (ETD) and standard stent removal (SSR). Herein, we compared the efficacy and safety of leaving long-term indwelling plastic stents (LTIS) vs. standard stent removal after PFC resolution with ETD.

Methods

We performed a systematic review of MEDLINE, EMBASE, CINAHL, Scopus, and Cochrane databases from inception to September 2022. Full-text articles comparing long-term (> 6 months) outcomes of LTIS and SSR were eligible, as well as single-arm studies with ≥ 10 patients with LTIS. Two independent reviewers selected studies, extracted data, and assessed the risk of bias using the Newcastle–Ottawa Scale. Measured outcomes included the following: (A) PFC recurrence; (B) interventions for PFC recurrence; (C) technical success; and (D) adverse events (AEs). Meta-analysis was carried out using random-effects models.

Results

We included 16 studies, encompassing 1285 patients. Compared to SSR after PFC resolution with ETD, LTIS was associated with significantly lower risk of PFC recurrence (3% vs. 23%; OR 0.22 [95%CI 0.09–0.52]; I² = 45%) and need for interventions (2% vs. 14%; OR 0.35 [95%CI 0.16–0.78]; I² = 0%). The superiority of LTIS on reducing PFC recurrence was found with walled-off necrosis, with or without disconnected pancreatic duct, and with placement of ≥ 2 LTIS. When using LTIS, the pooled proportion of AEs was 8% (95%CI 4–11%) and technical success was 93% (95%CI 86–99%).

Conclusions

Our results show that LTIS after PFC resolution with ETD is feasible, safe, and superior to SSR in reducing the risk of PFC recurrence and need for interventions.

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Title: Efficacy and safety of long-term indwelling plastic stents after resolution of pancreatic fluid collections with endoscopic transmural drainage: a systematic review and meta-analysis
Authors: Fadi Hawa
Jean M. Chalhoub
Ana Vilela
Elit Quingalahua
Carol Shannon
George M. Philips
Richard S. Kwon
Erik-Jan Wamsteker
Allison R. Schulman
Matthew J. DiMagno
Jorge D. Machicado
Publication date: 20-03-2024
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 5/2024
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-024-10784-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Efficacy and safety of long-term indwelling plastic stents after resolution of pancreatic fluid collections with endoscopic transmural drainage: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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