Optimal timing for lumen-apposing metal stent removal following endoscopic ultrasound-guided drainage of pancreatic fluid collections: a systematic review and meta-analysis

Background Lumen-apposing metal stents (LAMSs) are widely used for endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs). Safety is a major concern and the timing of LAMS removal is debated owing to the risk of adverse events (AEs). Previous studies showed early stent removal was associated with a reduced risk of AEs, but data are still conflicting. The aim of this systematic review with meta-analysis was to identify the optimal timing for LAMS removal. Methods Major databases were systematically searched until May 2024. The outcome assessed was the cumulative incidence of AEs related to the early (within 3–4 weeks) versus late (after 3–4 weeks) removal of the LAMS. A random-effects (DerSimonian–Laird) model was used to pool the results. Results Eight studies (1820 patients; mean age 54–61.6 years; 63 % men) were included in the analysis. PFCs included walled-off necrosis (WON; 58.2 %) and pseudocysts (41.8 %). Pooled LAMS-related AEs rate were similar in the late versus early removal groups (risk ratio [RR] 1.03, 95 % CI 0.47–2.28; P = 0.94). Sensitivity analysis, including only studies applying a 4-week cut-off, confirmed a comparable AEs rate (RR 0.80, 95 %CI 0.38–1.65; P = 0.59). The mean (SD) follow-up of the studies was 208 (88) days. Conclusions The results of this meta-analysis showed no difference in the incidence of AEs between early and late removal of LAMSs in the presence of moderate heterogeneity across studies. Removal within 4 weeks is not warranted, and it may instead be planned on a clinical case-by-case basis according on the patient's condition.