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.

中文翻译：

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内镜透壁引流术解决胰腺积液后长期留置塑料支架的疗效和安全性：系统评价和荟萃分析

背景

通过内镜透壁引流 (ETD) 和标准支架移除 (SSR) 解决后，胰腺积液 (PFC) 可能会复发。在此，我们比较了使用 ETD 解决 PFC 后长期留置塑料支架 (LTIS) 与标准支架移除的疗效和安全性。

方法

我们对 MEDLINE、EMBASE、CINAHL、Scopus 和 Cochrane 数据库从成立到 2022 年 9 月进行了系统回顾。比较 LTIS 和 SSR 的长期（> 6 个月）结果的全文文章以及单臂研究均符合条件≥ 10 名 LTIS 患者的研究。两名独立评审员选择研究、提取数据并使用纽卡斯尔-渥太华量表评估偏倚风险。测量的结果包括以下内容：(A) PFC 复发； (B) 针对 PFC 复发的干预措施； (C) 技术上的成功； (D) 不良事件 (AE)。使用随机效应模型进行荟萃分析。

结果

我们纳入了 16 项研究，涵盖 1285 名患者。与 ETD 解决 PFC 后的 SSR 相比，LTIS 与显着降低的 PFC 复发风险相关（3% vs. 23%；OR 0.22 [95%CI 0.09–0.52]；I ²  = 45%）并且需要干预（2 % 与 14%；OR 0.35 [95%CI 0.16–0.78]；I ²  = 0%）。 LTIS 在减少 PFC 复发方面的优越性体现在有壁性坏死、有或没有胰管断开以及放置 ≥ 2 个 LTIS 的情况下。使用 LTIS 时，AE 的汇总比例为 8% (95%CI 4–11%)，技术成功率为 93% (95%CI 86–99%)。

结论

我们的结果表明，通过 ETD 解决 PFC 后的 LTIS 可行、安全，并且在降低 PFC 复发风险和干预需求方面优于 SSR。