title: Covered metal stent or multiple plastic stents for refractory pancreatic ductal strictures in chronic pancreatitis: a systematic review.
abstract: OBJECTIVE
  Refractory chronic pancreatitis has been proposed as a challenge for endoscopists following routine single plastic stenting. However, data on the efficacy and safety of further endoscopic stenting are still controversial. The current systematic review aimed to assess the efficacy and safety of placement of fully covered self-expandable metal stent (FCSEMS) and multiple plastic stents.
  
  
  METHODS
  Databases including MEDLINE, EMBASE, the Cochrane Library, CBM, CNKI, VIP, and WANFANG Database were used to search relevant trials. Published studies were assessed by using well-defined inclusion and exclusion criteria. The process was independently performed by two investigators.
  
  
  RESULTS
  A total of 5 studies provided data of 80 patients. Forest plots and publication bias were not carried out because few studies were relevant and screened studies were all case series. The technical success rate was 100% both in placement of FCSEMS and multiple plastic stents. The functional success rate after placement of FCSEMS was 100%, followed by multiple plastic stents (94.7%). Complications occurred 26.2% after FCSEMS placement, which was not described in detail in multiple plastic stents. The stent migration rate was 8.2% for FCSEMS and 10.5% for multiple plastic stents. Reintervention rate was 9.8% for FCSEMS and 15.8% for multiple plastic stents. Pain improvement rate was 85.2% for FCSEMS and 84.2% for multiple plastic stents.
  
  
  CONCLUSIONS
  FCSEMS appeared to be no significant difference with multiple plastic stents in treatment of refractory chronic pancreatitis. We need to develop more investigations.
authors.affiliation: Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, PR China.
authors.forename: Yonghua
authors.initials: Y
authors.lastname: Shen
authors.affiliation: Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, PR China.
authors.forename: Mingdong
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, PR China.
authors.forename: Min
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, PR China.
authors.forename: Yunhong
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, PR China. Electronic address: lying1999@126.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University, Medical School, PR China. Electronic address: zouxiaoping795@hotmail.com.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Zou
mesh_terms: D001672:Biocompatible Materials; D002908:Chronic Disease; D003251:Constriction, Pathologic / Q000628:therapy; D006801:Humans; D008670:Metals; D010183:Pancreatic Ducts / Q000601:surgery*; D010195:Pancreatitis / Q000601:surgery*; D010969:Plastics; D011183:Postoperative Complications / Q000453:epidemiology; D011474:Prosthesis Design; D012086:Reoperation / Q000706:statistics & numerical data; D015607:Stents / Q000009:adverse effects
chemical_list: D001672:Biocompatible Materials; D008670:Metals; D010969:Plastics
keywords: Chronic pancreatitis; FCSEMS; Multiple plastic stents; Refractory duct stricture; Systematic review