Do lumen-apposing metal stents (LAMS) improve treatment outcomes of walled-off pancreatic necrosis over plastic stents using dual-modality drainage?

Nadav Sahar, Richard Kozarek, Zaheer S Kanji, Andrew S Ross, Michael Gluck, S Ian Gan, Michael Larsen, Shayan Irani, Nadav Sahar, Richard Kozarek, Zaheer S Kanji, Andrew S Ross, Michael Gluck, S Ian Gan, Michael Larsen, Shayan Irani

Abstract

Background and study aims: Endoscopic ultrasound-guided drainage of symptomatic walled-off pancreatic necrosis (WON) usually has been performed with double pigtail plastic stents (DPS) and more recently, with lumen-apposing metal stents (LAMS). However, LAMS are significantly more expensive and there are no comparative studies with DPS. Accordingly, we compared our experience with combined endoscopic and percutaneous drainage (dual-modality drainage [DMD]) for symptomatic WON using LAMS versus DPS.

Patients and methods: Patients who underwent DMD of WON between July 2011 and June 2016 using LAMS were compared with a matched group treated with DPS. Technical success, clinical success, need for reintervention and adverse events (AE) were recorded.

Results: A total of 50 patients (31 males, 25 patients treated with LAMS and 25 patients treated with DPS) were matched for age, sex, computed tomography severity index, and disconnected pancreatic ducts. Technical success was achieved in all patients. Mean days hospitalized post-intervention (14.5 vs. 13.1, P = 0.72), time to resolution of WON (77 days vs. 63 days, P = 0.57) and mean follow-up (207 days vs. 258 days, P = 0.34) were comparable in both groups. AEs were similar in both groups (6 vs. 8, P = 0.53). Patients treated with LAMS had significantly more reinterventions per patient (1.5 vs. 0.72, P = 0.01).

Conclusions: In treatment of symptomatic WON using DMD, LAMS did not shorten time to percutaneous drain removal and was not associated with fewer AEs.

Conflict of interest statement

Competing interests Dr. Irani is a consultant for Boston Scientific with remittance to the clinic. Dr. Ross is a consultant for Boston Scientific with remittance to the clinic. Dr. Kozarek received paid research support for the medical center for 3 clinical trials supported by Boston Scientific which acquired Axios stent. None of the trials dealt with the Axios stent or the data presented in this manuscript.

Figures

Fig. 1 a
Fig. 1 a
Endoscopic view of a lumen-apposing metal stent (LAMS) deployed into the walled-off pancreatic necrosis (WON).bPlacement of a 7-Fr × 3-cm double pigtail stent (DPS) placed through it.cComputed tomography scan 3 weeks later demonstrates air in the WON (yellow arrow) with transgastric LAMS, pigtail stent and percutaneous drain (yellow arrowhead) in appropriate place.
Fig. 2 a
Fig. 2 a
A 7.5-MHz endoscopic ultrasound image of WON punctured with a 19-gauge needle to create a cystgastrostomy.bEndoscopic image of 2 7Fr × 3-cm double pigtail stents placed into the WON through the cystgastrostomy.cComputed tomography image of a transgastric double pigtail stent and percutaneous drain within the WON.
Fig. 3 a
Fig. 3 a
Endoscopic view of the splenic flexure demonstrating migration of lumen-apposing metal stent (LAMS) into the colon (colonic fistula).bFluoroscopic view of a persistent fistula 3 months later.cDeployment of a 12/6a over the scope clip to successfully close the fistula.

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Source: PubMed

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