P1420 - Flared-Type Bi-Flanged vs Lumen-Apposing Metal Stents for Endoscopic Drainage of Pancreatic Walled-Off Necrosis: A Systematic Review and Meta-Analysis

Azizullah Beran, MD¹, Mouhand FH. Mohamed, MD², Itegbemie Obaitan, MD, MPH³, Renato Beas, MD¹, Eleazar E.. Montalvan-Sanchez, MD³, Sarah Yates, DO¹, Fouad Jaber, MD⁴, Khaled Elfert, MD⁵, Saqr Alsakarneh, MD⁴, Alejandra Vargas, MD⁶, Tarek Aboursheid, MD⁷, Syed Hamaad Rahman, DO⁸, Hisham Wehbe, MD³, Wasef Sayeh, MD⁹, Marcel Ghanim, MD¹⁰, Mohammad Al-Haddad, MD^1
1Indiana University, Indianapolis, IN; ²Brown University, Providence, RI; ³Indiana University School of Medicine, Indianapolis, IN; ⁴University of Missouri-Kansas City, Kansas City, MO; ⁵SBH Health System, Bronx, NY; ⁶Eastern Virginia Medical School, Norfolk, VA; ⁷Ascension Saint Francis Hospital, Chicago, IL; ⁸Methodist Dallas Medical Center, Dallas, TX; ⁹University of Toledo, Toledo, OH; ¹⁰Loyola University, Chicago, IL

Introduction: Endoscopic transluminal drainage using stents and necrosectomy are preferred treatments for symptomatic pancreatic walled-off necrosis (WON) due to their efficacy and reduced morbidity/mortality rates. Self-expanding metal stents (SEMS) are preferred over plastic stents for WON drainage. The most used SEMSs for drainage of pancreatic WON are lumen-apposing metal stents (LAMS), including the only one that is FDA approved in the US (AXIOS, Boston Scientific, Natick, MA) and other stents available in other countries such as the flared-type bi-flanged metal stent (FBFMS) (NAGI stent, Taewoong Medical, South Korea). However, studies comparing these two stents in managing pancreatic WON are scarce, given the relatively small sample size and lack of comparative arms. Our study aimed to compare FBFMS and LAMS in terms of technical success, clinical success, and adverse events for EUS-guided drainage of pancreatic WON.

Methods: We conducted a comprehensive literature search for studies reporting outcomes of FBFMS or LAMS in treating WON. We excluded studies evaluating pancreatic fluid collections other than WON. The outcomes were technical success, clinical success (WON resolution), total AEs, stent migration, and stent occlusion with each type of stent (FBFMS and LAMS). The pooled proportions of our data with the corresponding 95% confidence intervals (CIs) were analyzed using the random-effects model, and between-group comparisons of proportions were computed.

Results: We included 49 studies (14 FBFMS and 37 LAMS) with a total of 837 FBFMS patients and 2,444 LAMS patients. The pooled rates for FBFMS were: technical success 98.9%, clinical success 90.3% (Figure 1), total AEs 21.8%, stent migration 6.9%, and stent occlusion 10.4% (Table 1). For LAMS, the pooled rates were: technical success 99.4%, clinical success 90.1% (Figure 1), total AEs 21.4%, stent migration 4.1%, and stent occlusion 7.6% (Table 1). There were no significant differences in technical success, clinical success, total AEs, or stent occlusion between FBFMS and LAMS. However, FBFMS had a significantly higher stent migration rate compared to LAMS (6.9% vs. 4.1%, P=0.006) (Table 1).

Discussion: Our meta-analysis shows that FBFMS and LAMS have similar technical and clinical success rates, total adverse events, and stent occlusion in managing pancreatic WON. However, FBFMS has a higher stent migration rate. Randomized controlled trials are needed to confirm these findings.



Disclosures:


Azizullah Beran, MD¹, Mouhand FH. Mohamed, MD², Itegbemie Obaitan, MD, MPH³, Renato Beas, MD¹, Eleazar E.. Montalvan-Sanchez, MD³, Sarah Yates, DO¹, Fouad Jaber, MD⁴, Khaled Elfert, MD⁵, Saqr Alsakarneh, MD⁴, Alejandra Vargas, MD⁶, Tarek Aboursheid, MD⁷, Syed Hamaad Rahman, DO⁸, Hisham Wehbe, MD³, Wasef Sayeh, MD⁹, Marcel Ghanim, MD¹⁰, Mohammad Al-Haddad, MD¹. P1420 - Flared-Type Bi-Flanged vs Lumen-Apposing Metal Stents for Endoscopic Drainage of Pancreatic Walled-Off Necrosis: A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.