• Hayat Khizar, Hu Yufei, Wu Yanhua, Chen Wangyang, Bian Ying, Le Chenyu, Huang Zhicheng, Kamran Ali, and Yang Jianfeng.
• Department of Gastroenterology, International Education College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
• Ann. Med. 2023 Dec 1; 55 (1): 578591578-591.

BackgroundPatients with walled-off necrosis (WON) are still challenging to treat safely and effectively. Recently, double-pigtail plastic stents (DPS), bi-flanged metallic stents (BFMS), and lumen-apposing metal stents (LAMS) have been employed with endoscopic ultrasound-guided (EUS-guided) drainage. However, there is little solid evidence to support the effectiveness and safety of using stents. This study aims to compare the outcomes of the LAMS and the PS.MethodTill July 2022, a thorough database search was done, and studies that met the criteria were chosen. By using the RevMan software, the technical and clinical success and other secondary outcomes were calculated. Subgroup analysis was performed between the LAMS and the BFMS.ResultsFifteen studies (two randomized controlled trials and thirteen observational) with 687 patients receiving metal stents and 771 patients receiving plastic stents were selected for final analysis. There was no significant risk of bias or publication bias. The odds ratios (OR) for technical and clinical success were 0.36 (95% confidence interval (95% CI) 0.08, 1.52) and 2.26 (95%CI 1.62, 3.15), respectively. The OR for overall adverse events was 0.74 (95% CI 0.41, 1.34). In subgroup analysis, the LAMS and the BFMS showed the same outcomes.ConclusionCompared to DPS, LAMS had better clinical outcomes and fewer side effects when treating patients with WON.

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