Lumen-Apposing Metal Stent With and Without Concurrent Double-Pigtail Plastic Stent for Pancreatic Fluid Collections: A Comparative Systematic Review and Meta-Analysis

Background: Lumen-apposing metal stents (LAMSs) are often used to drain pancreatic fluid collections (PFCs). However, adverse events, such as stent obstruction, infection, or bleeding, have been reported. Concurrent double-pigtail plastic stent (DPPS) deployment has been suggested to prevent these adverse events. This meta-analysis aimed to compare the clinical outcomes of LAMS with DPPS vs. LAMS alone in the drainage of PFCs. Methods: An extensive search was conducted in the literature to in-clude all the eligible studies that compared LAMS with DPPS vs. LAMS alone for drainage of PFCs. Pooled risk ratios (RRs) with the 95% confidence intervals (CIs) were obtained within a random-effect model. The outcomes were technical and clinical success, and overall adverse events, including stent migration and occlusion, bleeding, in-fection, and perforation. Results: Five studies involving 281 patients with PFCs (137 received LAMS plus DPPS vs. 144 received LAMS alone) were included. LAMS plus DPPS group was associated with comparable technical success (RR: 1.01, 95% CI: 0.97 -1.04, P = 0.70) and clinical success (RR: 1.01, 95% CI: 0.88 -1.17). Lower trends of overall adverse events (RR: 0.64, 95% CI: 0.32 -1.29), stent occlusion (RR: 0.63, 95% CI: 0.27 -1.49), infection (RR: 0.50, 95% CI: 0.15 -1.64), and perforation (RR: 0.42, 95% CI: 0.06 -2.78) were observed in LAMS with DPPS group compared to LAMS alone but without a statistical significance. Stent migration (RR: 1.29, 95% CI: 0.50 -3.34) and bleeding (RR: 0.65, 95% CI: 0.25 -1.72) were similar between the two groups. Conclusions: Deployment of DPPS across LAMS for drainage of PFCs has no significant impact on efficacy or safety outcomes. Ran-domized, controlled trials are necessary to confirm our study results, especially in walled-off pancreatic necrosis.