Efficacy and safety of fully covered self-expandable metal stents in the management of postsphincterotomy bleeding: systematic review and meta-analysis

Abstract

Background and aims: Fully covered self-expandable metal stents (FCSEMSs) are often used in the management of postsphincterotomy bleeding that is refractory to conventional endoscopic treatments. In this meta-analysis, we evaluated the efficacy and safety of FCSEMSs in the management of postsphincterotomy bleeding.

Methods: We reviewed several databases from inception to November 6, 2024 to identify studies that evaluated the efficacy and/or safety of FCSEMSs in the management of postsphincterotomy bleeding. Our outcomes of interest were clinical success, recurrent bleeding, adverse events, stent migration, and pancreatitis. Subgroup analyses were performed by including studies in which FCSEMSs were used as a rescue treatment after failure of conventional endoscopic treatments. We calculated pooled rates with 95% confidence intervals (CIs) for our outcomes of interest. Data were analyzed using a random-effects model.

Results: We included 7 studies with 224 patients. Pooled rates of clinical success were 95% (95% CI, 89-98), of recurrent bleeding were 7% (95% CI, 4-12), and of adverse events were 6% (95% CI, 2-16). Pooled rates of pancreatitis were 7% (95% CI, 2-19) and of stent migration were 10% (95% CI, 5-20). In most studies, FCSEMSs were used after failure of conventional endoscopic treatments, except in 2 studies in which FCSEMSs were used in some patients for primary treatment and in others after failure of conventional endoscopic treatments CONCLUSIONS: Our meta-analysis demonstrates the pooled efficacy and safety of FCSEMSs in the management of postsphincterotomy bleeding, especially as a rescue treatment in patients with persistent bleeding after conventional endoscopic treatments.