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Comparative efficacy and safety of bi-flanged metal stents versus lumen-apposing metal stents for endoscopic drainage of pancreatic fluid collections: a systematic review and meta-analysis.

Muhammad Shahzil·Muhammad Hashim Faisal·Muhammad Hammad Khan·Syeda Fatima Abid·Minahel Shehzadi·Muhammad Saad Faisal·Ammad Javaid Chaudhary·Muhammad Sheharyar Warraich·Jennifer L Maranki
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Abstract

INTRODUCTION: Pancreatic fluid collections (PFCs), particularly walled-off necrosis, are common complications of acute pancreatitis that often require endoscopic drainage. Bi-flanged metal stents (BFMS; NAGI; Taewoong Medical, Gyenoggi-do, Korea) and electrocautery-enhanced lumen-apposing metal stents (LAMS; AXIOS, Boston Scientific Corporation, Marlborough, Massachusetts, USA) are frequently used, but comparative data remain limited. This study aims to compare the efficacy and safety of BFMS and LAMS in the endoscopic drainage of PFCs. METHODS: This meta-analysis followed the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comprehensive database searches were conducted through November 2024 to identify studies comparing BFMS and LAMS for endoscopic ultrasound-guided drainage of PFCs. Outcomes were pooled using a random-effects model with RevMan Web, and statistical significance was defined as a P value less than 0.05. RESULTS: Three studies ( n  = 627; 329 BFMS and 298 LAMS) met inclusion criteria. No significant differences were observed between BFMS and LAMS for technical success [odds ratio (OR): 1.16; 95% confidence interval (CI): 0.55-2.43] or clinical success (OR: 0.97; 95% CI: 0.51-1.87). Similarly, there were no differences in walled-off necrosis recurrence (OR: 2.01; 95% CI: 0.17-24.02), number of direct endoscopic necrosectomy sessions (OR: 0.52; 95% CI: 0.05-5.12), or mean number of endoscopic procedures (mean difference: 0.18, 95% CI: 2.08-2.45). Adverse events were also comparable between groups, including bleeding (OR: 0.64), infection (OR: 1.18), stent migration (OR: 1.83), and stent occlusion/dysfunction (OR: 1.71). CONCLUSION: BFMS and LAMS provide equivalent efficacy and safety in the endoscopic ultrasound-guided drainage of PFCs. Either stent type represents a viable therapeutic option. Further large-scale prospective studies are warranted to refine stent selection strategies.

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HumansDrainageStentsPancreatitisEndosonographyTreatment OutcomeMetalsProsthesis DesignPancreatitis, Acute NecrotizingUltrasonography, Interventionalbi-flanged metal stentsendoscopic ultrasound-guided drainagelumen-apposing metal stentspancreatic fluid collectionswalled-off necrosisJournal ArticleSystematic ReviewMeta-AnalysisComparative Study

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Muhammad Shahzil, Muhammad Hashim Faisal, Muhammad Hammad Khan, Syeda Fatima Abid, Minahel Shehzadi, Muhammad Saad Faisal, Ammad Javaid Chaudhary, Muhammad Sheharyar Warraich, Jennifer L Maranki. 2026-03-27. Comparative efficacy and safety of bi-flanged metal stents versus lumen-apposing metal stents for endoscopic drainage of pancreatic fluid collections: a systematic review and meta-analysis.. https://doi.org/10.1097/meg.0000000000003190

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