Efficacy and safety of fully covered self-expanding metal stents in the management of Post sphincterotomy bleeding: a Systematic Review and Meta-analysis

Background and aims: Fully covered self-expandable metallic stents (FCSEMS) are often used in the management of post-sphincterotomy bleeding which is refractory to conventional endoscopic treatments. In this meta-analysis, we have evaluated the efficacy and safety of FCSEMS in the management of post-sphincterotomy bleeding.

Methods: We reviewed several databases from inception to November 6, 2024 to identify studies that evaluated the efficacy, and/or safety of FCSEMS in the management of post sphincterotomy bleeding. Our outcomes of interest were clinical success, rebleeding, adverse events, stents migration, and pancreatitis. Subgroup analyses were performed by including studies where FCSEMS were used as a rescue treatment after failure of conventional endoscopic treatments. We calculated pooled rates with 95% confidence intervals (CI) for our outcomes of interest. Data was analysed using a random effect model.

Results: We included 7 studies with 224 patients. Pooled rates (95%CI) of clinical success were 95% (89%, 98%). Pooled rates (95%CI) of rebleeding and adverse events were 7% (4%, 12%) and 6% (2%, 16%) respectively. Pooled rates (95%CI) of pancreatitis were 7% (2%, 19%). Pooled rates (95% CI) of stent migration were 10% (5%, 20%). In most studies, FCSEMS were used after failure of conventional endoscopic treatments except in two studies, where these 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 FCSEMS in the management of post-sphincterotomy bleeding especially as a rescue treatment in patients with persistent bleeding after conventional endoscopic treatments.