Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Medicine
Comparative safety and effectiveness of stents in drainage of pancreatic fluid collections guided by endoscopic ultrasonography: A systematic review and network meta-analysis
BACKGROUND: Endoscopic ultrasonography-guided drainage is an effective treatment for pancreatic fluid collections (PFCs). However, the optimal stent strategy for endoscopic ultrasonography-guided drainage of PFCs is still unclear. This study aims to compare the clinical outcomes of different stent types to identify the best option. METHODS: Databases including PubMed, EMBASE, and Cochrane were searched up to August 2024. The analysis focused on comparisons between bi-flanged metal stents (BFMS), double-pigtail plastic stents (DPPS), fully covered self-expanding metal stents (FCSEMS), lumen-apposing metal stents (LAMS), and the combination of LAMS and DPPS (LAMS + DPPS). RESULTS: A total of 38 studies, involving 4265 patients with PFCs, were analyzed. In all of these patients, LAMS (risk ratio [RR]: 1.07, 95% confidence interval [CI]: 1.02-1.13) and BFMS (RR: 1.08, 95% CI: 1.01-1.15) showed higher clinical success rates compared with DPPS. LAMS + DPPS reduced infection rates compared with BFMS (RR: 0.32, 95% CI: 0.10-0.99), DPPS (RR: 0.19, 95% CI: 0.06-0.62), and FCSEMS (RR: 0.23, 95% CI: 0.07-0.76). Within the pancreatic pseudocysts subgroup, LAMS (RR: 1.08, 95% CI: 1.01-1.16) and LAMS + DPPS (RR: 1.24, 95% CI: 1.03-1.48) demonstrated higher clinical success rates compared with DPPS. Similarly, in the walled-off necrosis subgroup, LAMS (RR: 1.10, 95% CI: 1.02-1.17), LAMS + DPPS (RR: 1.19, 95% CI: 1.01-1.41), FCSEMS (RR: 1.14, 95% CI: 1.03-1.26), and BFMS (RR: 1.11, 95% CI: 1.03-1.20) all showed higher success rates compared with DPPS, with BFMS exhibiting a lower bleeding rate than DPPS (RR: 0.32, 95% CI: 0.18-0.99). CONCLUSION: Newer metal stents, including BFMS, LAMS, and LAMS + DPPS, offer advantages over plastic stents like DPPS alone. BFMS is preferable when bleeding risk is a concern, while LAMS + DPPS is more effective in reducing infection rates in PFCs.
26 July 2026
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Revealing the temporal metabolic trajectory and potential pharmacodynamic substances of Da-Cheng-Qi Decoction in treating patients with acute pancreatitis: A serum metabolomics-based study
ETHNOPHARMACOLOGICAL RELEVANCE: Acute Pancreatitis (AP) is a pancreatic inflammatory disease lacking specific therapeutics. Da-Cheng-Qi Decoction (DCQD) has been proven to alleviate the severity and mortality of AP. However, its underlying mechanisms remain to be fully elucidated. AIM OF THE STUDY: This study aimed to explore DCQD's dynamic metabolic regulatory effects on AP patients and potential pharmacodynamic substances via serum metabolomics and serum pharmacochemistry analysis, with validation in animal models. MATERIALS AND METHODS: AP patients were randomized into conventional therapy (Con) and Con + DCQD groups. Fasting venous blood samples were collected at four time points (admission, 24 h/96 h post-admission, pre-discharge) for biochemical assays and UHPLC-Q-Exactive-Orbitrap-MS analysis. Metabolomics was used to screen AP-related biomarkers, evaluate the two regimens' reversal effects, and compare inter-group differences in metabolic recovery trajectories. Prototypes and metabolites of DCQD were identified, with potential pharmacodynamic substances screened via correlation analysis with AP biomarkers. L-arginine-induced SAP mouse model was used for validation. RESULTS: Serum amylase normalization and C-reactive protein decline were accelerated in Con + DCQD group. Both regimens reversed AP-related energy, amino acid, and lipid metabolic disorders. Adjuvant DCQD therapy accelerated inflammation alleviation and energy homeostasis restoration in early stage, and improved lipid metabolism more comprehensively in middle-to-late stage, with efficacy validated in SAP mice. Forty-eight and 35 blood-migrated components were identified in patients and mice, respectively, with 8 key pharmacodynamic substances screened. CONCLUSIONS: Integrating serum metabolomics and multi-time-point monitoring, this study delineated AP's metabolic recovery trajectory and clarified DCQD's efficacy and dynamic metabolic regulation, providing guidance for its clinical application.
12 June 2026
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