BACKGROUND AND AIMS: Pancreatic fluid collections (PFCs), including walled-off necrosis (WON), are significant complications of acute pancreatitis, and their management often involves drainage, although the optimal type of stent for this purpose remains uncertain. This meta-analysis aimed to compare metal versus plastic stents for endoscopic ultrasound (EUS)-guided drainage of PFCs. METHODS: We searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) comparing metal with plastic stents for drainage of PFCs. The odds ratio (OR) was used for binary outcomes and the mean difference (MD) for continuous outcomes with their respective 95% confidence interval (CI). RESULTS: This study included eight RCTs and over 500 patients. Procedure duration was shorter in the metal stent arm compared with the plastic stent arm (MD - 10.63
95% CI - 16.12 to - 5.15, p <
0.001). However, there was no statistically significant difference between metal and plastic stents in clinical success (OR 1.10
95% CI 0.56 to 2.14), technical success (OR 1.53
95% CI 0.23 to 10.0), overall mortality (OR 0.75
95% CI 0.34 to 1.67), recurrence (OR 1.76
95%CI 0.70 to 4.44), total number of interventions (MD 0.06
95% CI - 0.52 to 0.64), need of necrosectomy (OR 1.27
95% CI 0.77 to 2.11), length of hospitalization (MD - 0.41
95% CI - 5.10 to 4.27), exocrine insufficiency (OR 1.37
95% CI 0.50 to 3.71), endocrine insufficiency (OR 1.11
95% CI 0.57 to 2.16), and adverse events (OR 0.74
95% CI 0.39 to 1.41). CONCLUSION: Metal stents for EUS-guided drainage of WON are associated with a shorter procedure duration. Besides that, it may not improve other clinically relevant outcomes in comparison with plastic stents.