Metal vs. Plastic Stents for Pancreatic Walled-Off Necrosis

Summary and Comment |
September 13, 2017

Metal vs. Plastic Stents for Pancreatic Walled-Off Necrosis

  1. Douglas G. Adler, MD, FACG, AGAF, FASGE

A meta-analysis suggests superiority of metal stents for safely achieving collection resolution.

  1. Douglas G. Adler, MD, FACG, AGAF, FASGE

Endoscopic necrosectomy is now widely performed as a primary treatment for pancreatic necrosis; however, there is currently no standardized technique for accessing and debriding pancreatic fluid collections, such as pseudocysts or pancreatic walled-off necrosis. Traditionally, cystenterostomies between pancreatic fluid collections and the stomach or bowel were held open by plastic stents, although now metal stents (most commonly lumen-apposing metal stents), are frequently used. Plastic stents are inexpensive but cumbersome compared with metal stents.

To compare the efficacy of plastic and metal stents for draining pancreatic walled-off necrosis, researchers performed a meta-analysis of data from 41 studies involving more than 2000 patients. In the five studies with multiple arms, necrosis resolution was more likely with use of metal versus plastic stents (odds ratio, 3). Resolution with only a single endoscopic procedure occurred in similar proportions across groups (47% and 44%, respectively). Among those requiring more than one intervention, the metal stent group required fewer procedures. In single-arm studies, use of metal stents was associated with less-frequent bleeding (6% vs. 13%) and nonsignificant trends toward fewer perforations (3% and 4%) and stent occlusion events (10% and 17%) but a higher frequency of migration (8% and 5%).

Comment

This meta-analysis showed more pancreatic fluid collection resolutions, and with fewer interventions, with use of metal versus plastic stents. There were fewer adverse events seen with metal stents as well. While plastic stents remain a viable option for these patients, it seems likely that despite their higher cost, metal stents will become the primary device used in this setting going forward.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Editor Disclosures at Time of Publication

  • Disclosures for Douglas G. Adler, MD, FACG, AGAF, FASGE at time of publication Consultant / Advisory board BSC; Merit Speaker’s bureau Abbvie Editorial boards Gastrointestinal Endoscopy Leadership positions in professional societies American College of Gastroenterology (Vice Chair, Board of Governors)

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