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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(02): E188-E198
DOI: 10.1055/a-2226-1237
Review

Risk of recurrence with or without plastic stent after EUS-guided treatment of peripancreatic fluid collections: A systematic review and meta-analysis

Takuji Iwashita  ‡
1   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan (Ringgold ID: RIN476117)
,
Tatsuya Sato  ‡
2   Department of Gastroenterology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
,
Tsuyoshi Hamada
2   Department of Gastroenterology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
3   Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
,
Tomotaka Saito 
2   Department of Gastroenterology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
,
Keisuke Iwata
4   Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan (Ringgold ID: RIN38226)
,
Hideyuki Shiomi
5   Division of Hepatobiliary and Pancreatic Diseases, Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan (Ringgold ID: RIN12818)
,
Mamoru Takenaka 
6   Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
,
Akinori Maruta
7   Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan (Ringgold ID: RIN68266)
,
Shinya Uemura
1   First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan (Ringgold ID: RIN476117)
,
Atsuhiro Masuda
8   Department of Gastroenterology, Kobe University Graduate School of Medicine, Hyogo, Japan
,
Saburo Matsubara 
9   Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
,
Tsuyoshi Mukai
10   Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan (Ringgold ID: RIN12857)
,
Hiroyuki Isayama 
11   Department of Gastroenterology, Juntendo University Graduate School of Medicine, Tokyo, Japan
,
Ichiro Yasuda‡
12   Third Department of Internal Medicine, University of Toyama, Toyama, Japan
,
Yousuke Nakai  ‡
2   Department of Gastroenterology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
13   Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan (Ringgold ID: RIN26782)
› Author AffiliationsSupported by: Takeda Science Foundation
Supported by: Japan Society for the Promotion of Science (JSPS) KAKENHI grants JP19K08362
Supported by: Japan Society for the Promotion of Science (JSPS) KAKENHI grants JP22H02841
Supported by: The Japanese Foundation for Research and Promotion of Endoscopy (#1015)

Clinical Trial: Registration number (trial ID): UMIN000050959, Trial registry: UMIN Japan (http://www.umin.ac.jp/english/), Type of Study: A systematic review and meta-analysis
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Abstract

Background and study aims Recent advances in endoscopic transmural treatment have improved the clinical outcomes of patients with pancreatic fluid collections (PFCs). However, there is still a debate about the preventive effect of long-term placement of a transmural plastic stent (PS) on recurrence after successful endoscopic ultrasound (EUS)-guided treatment of PFCs. We conducted a systematic review and meta-analysis to evaluate PFC recurrence rates with and without a transmural PS after EUS-guided treatment.

Patients and methods A systematic literature search of PubMed, Embase, and the Cochrane database was conducted to identify clinical studies comparing outcomes with and without transmural PS published until September 2022. Data on PFC recurrence and adverse events (AEs) were pooled using a random-effects model.

Results Nine studies including 380 patients with long-term transmural PS and 289 patients without PS were identified. The rate of PFC recurrence was significantly lower in patients with transmural PS (pooled odds ratio [OR] = 0.23, 95% confidence interval [CI] [0.08-0.65], P = 0.005). In a subgroup analysis limited to studies focusing on patients with disconnected pancreatic duct syndrome, which has been reported to be a risk factor for PFC recurrence, the OR was numerically lower than that for the entire cohort (OR = 0.14, 95% CI [0.04-0.46]). The rate of AEs was significantly higher with long-term transmural PS (OR = 14.77, 95% CI [4.21-51.83]).

Conclusions In this meta-analysis, long-term PS placement reduced the risk of PFC recurrence. Given the potential AEs of indwelling PS, further research is required to evaluate the overall benefits of long-term PS placement.

Keywords

Intervention EUS - Pancreas - Endoscopic ultrasonography - Biliary tract


Publication History

Received: 01 August 2023

Accepted after revision: 06 December 2023

Accepted Manuscript online:
11 December 2023

Article published online:
12 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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