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The following is a summary of “EUS-guided Drainage of Pancreatic Fluid Collections Using Lumen Apposing Metal Stents With or Without Coaxial Plastic Stents,” published in the January 2025 issue of Gastroenterology by Kamal et al.

This meta-analysis examines the efficacy and safety of using co-axial plastic double pigtail stents (DPSs) in conjunction with lumen-apposing metal stents (LAMS) compared to LAMS alone for the management of pancreatic fluid collections (PFCs). Co-axial DPSs are frequently deployed through LAMS to mitigate adverse events associated with PFC treatment. The analysis aims to evaluate the overall adverse event rates, clinical success, and specific complications such as stent migration, stent occlusion, bleeding, and infection in patients treated with these two approaches.

Researchers systematically reviewed several databases to identify relevant studies that compared the outcomes of LAMS with co-axial DPS to LAMS without DPS. The primary outcomes were the rate of adverse events, clinical success, and specific adverse events, including stent migration, occlusion, bleeding, and infection. Pooled risk ratios (RR) with 95% (CIs) were calculated for each outcome using a random effects model to account for potential variability across studies. The I² statistic was employed to assess heterogeneity among the included studies.

The meta-analysis incorporated data from 10 studies encompassing 685 patients. The results indicated a significantly lower rate of overall adverse events in the LAMS+DPS group compared to the LAMS-alone group (RR 0.58, 95% CI 0.40–0.87). Clinical success rates between the two groups were similar, with no significant difference observed (RR 1.03, 95% CI 0.94–1.13). Stent occlusion rates did not differ significantly between groups. However, the LAMS+DPS group experienced a significantly lower rate of infection (RR 0.46, 95% CI 0.24–0.85). There were no significant differences in the rates of bleeding or stent migration between the two groups.

In conclusion, the addition of co-axial DPS to LAMS significantly reduces the risk of adverse events, particularly infections, in the treatment of PFCs. These findings suggest that incorporating co-axial DPS should be considered as a standard adjunct to LAMS in patients undergoing PFC management to enhance safety outcomes.

Source: journals.lww.com/jcge/abstract/2025/01000/eus_guided_drainage_of_pancreatic_fluid.7.aspx