Reem Z. Sharaiha, MD, MSc, from Weill Cornell Medical College in New York, New York, USA, describes this Original Article, “Metal versus plastic for pancreatic pseudocyst drainage: clinical outcomes and success.”

Our aim was to compare fully covered self-expanding metal stents (FCSEMSs) to plastic stents for endoscopic drainage of pancreatic pseudocyst drainage in terms of the overall outcomes, the success rate, including predictors of success, and adverse events.

Pancreatic pseudocysts (PP) develop as a result of pancreatic ductal damage or as an adverse event of acute or chronic pancreatitis, these resolve spontaneously. In certain cases, these collections can become infected, increase in size, and cause symptoms ranging from abdominal pain, early satiety, jaundice to gastric outlet obstruction. In such instances, intervention is needed. EUS-guided transluminal drainage of pseudocysts has traditionally been performed using plastic stents. However recently there has been a trend to use fully covered metal stents. Metals stents are easier to deploy than plastic stents and preclude the need for multiple plastic stents. To date there has been no comparative study between metal and plastic stents.

EUS guided drainage of pseudocysts using FCSEMSs is safe and effective. Our present study is unique in that it is directly compares EUS-guided pancreatic pseudocyst drainage using plastic stents and FCSEMSs. Our large retrospective study demonstrates that complete resolution of pancreatic pseudocysts using FCSEMSs was higher when compared to using plastic stents.

This study also demonstrates that metal stents were the sole predictor for resolution even after adjusting for size, age, sex, and number of endoscopic sessions. The increased likelihood of pseudocyst resolution with FCSEMSs can be attributed to the fact that they offer a larger diameter for drainage and decreased risk of in-stent occlusion compared to the double pigtail stents. When using plastic stents, the cavity might need to be accessed more than one time with replacement of any occluded stents. Patients with plastic stents were 3 times more likely to have adverse events as compared to metal stents.

Drainage of PP using FCSEMSs results in better clinical outcomes and lower adverse events when compared to those drained via plastic stents.

The clinical implication of this study is that pancreatic pseudocysts drained by metal stents may improve success of drainage and reduce adverse events.

Find the abstract for this article online.

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