title: Efficacy of metal and plastic stents for transmural drainage of pancreatic fluid collections: a systematic review.
abstract: OBJECTIVE
  Metal stents are being used more frequently for transmural endoscopic drainage of pancreatic fluid collections (PFC) despite lack of data. The present systematic review was conducted to compare the rates of treatment success, adverse events and recurrence between patients undergoing metal versus plastic stent placement for endoscopic transmural drainage of PFC.
  
  
  METHODS
  MEDLINE and EMBASE were searched to identify all published manuscripts that evaluated metal stents for endoscopic transmural drainage of PFC. All published studies from the same period involving plastic stent placement for PFC drainage that included >50 patients were also identified. Main outcome measures were to compare the rates of treatment success, adverse events and recurrence between the metal and plastic stent cohorts.
  
  
  RESULTS
  Seventeen studies (881 patients) met inclusion criteria. There was no difference in overall treatment success between patients treated with plastic and metal stents (81% [95% CI, 77-84%] vs 82% [95% CI, 74-88%]) for both pseudocysts (85% [95% CI, 81-89%] vs 83% [95% CI, 74-89%]) and walled-off necrosis (70% [95% CI, 62-76%] vs 78% [95% CI, 50-93%]). Also, there was no difference in the rates of adverse events (16% [95% CI, 14-39%] vs 23% [95% CI, 16-33%]) or recurrence (10% [95% CI, 8-13%] vs 9% [95% CI, 4-19%]) between plastic and metal stents.
  
  
  CONCLUSIONS
  Current evidence does not support routine placement of metal stents for transmural drainage of PFC. Randomized trials are needed to justify the use of metal stents for PFC drainage.
authors.affiliation: Division of Gastroenterology & Hepatology, Indiana University, Indianapolis, USA.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Bang
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Hawes
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Bartolucci
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
mesh_terms: D004322:Drainage / Q000295:instrumentation*; D016145:Endoscopy, Digestive System / Q000295:instrumentation*; D004867:Equipment Design; D006801:Humans; D010189:Pancreatic Juice; D010192:Pancreatic Pseudocyst / Q000601:surgery*; D010969:Plastics; D000069322:Self Expandable Metallic Stents; D016896:Treatment Outcome
chemical_list: D010969:Plastics
keywords: metal stent; pancreatic fluid collection; pancreatic necrosis; plastic stent; pseudocyst