Efficacy and safety of metallic stents in comparison to plastic stents for endoscopic drainage of peripancreatic fluid collections: a meta-analysis and trial sequential analysis.

Metallic stents are being increasingly used for endoscopic drainage of peripancreatic fluid collections (PFCs) but their superiority over plastic stents has not been proven. We carried out a meta-analysis to consolidate the results from available studies and to suggest evidence-based recommendations. Studies that compared plastic and metallic stents for endoscopic drainage of PFCs and published before October 2016 were searched. Comparisons were performed for clinical success, adverse events, salvage interventions, mortality, technical success and recurrence. We included six studies with 856 patients (479 in the metallic stent group and 377 in the plastic stent group). The clinical success rate was significantly higher with metallic stents than with plastic stents (Mantel-Haenszel odds ratio [MH-OR] 3.22; 95% CI 1.87-5.54; P < 0.001). The rate of adverse events (MH-OR 0.40; 95% CI 0.24-0.65; P < 0.001) and the need for salvage procedures (MH-OR 0.31; 95% CI 0.13-0.70; P = 0.01) were also significantly lower with the use of metallic stents. Subgroup analysis for the type of PFC also found better results with the metallic stents. The results of Egger's regression test (X-axis intercept at -0.63, P = 0.47) and funnel plot did not suggest any significant publication bias. We conclude that compared to plastic stents, the use of metallic stents for endoscopic drainage of PFCs is associated with significantly better clinical success and significantly lower rates of adverse events and the need for salvage procedures. However, further high-quality randomized trials are required to confirm these findings.