Comparison Between Lumen-Apposing Metal Stents and Plastic Stents in Endoscopic Ultrasound–Guided Drainage of Pancreatic Fluid Collection

Lyu, Yunxiao; Li, Ting; Wang, Bin; Cheng, Yunxiao; Liang, Chen; Zhao, Sicong

doi:10.1097/mpa.0000000000001798

Cited by 19 publications

(15 citation statements)

References 34 publications

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“…When comparing DPT and LAMS for transluminal access to WON, a recent meta-analysis found LAMS to be significantly more clinically successful 20. However, the only randomised study published until now, by Bang et al , did not find any difference between DPT and LAMS when comparing key parameters, such as clinical success, LOS or mortality 11.…”

Section: Discussionmentioning

confidence: 99%

EUS-guided drainage of large walled-off pancreatic necroses using plastic versus lumen-apposing metal stents: a single-centre randomised controlled trial

Karstensen

Novovic

Hansen

et al. 2022

Gut

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ObjectiveIn treating pancreatic walled-off necrosis (WON), lumen-apposing metal stents (LAMS) have not proven superior to the traditional double pigtail technique (DPT). Among patients with large WON (>15 cm) and their associated substantial risk of treatment failure, the increased drainage capacity of a novel 20-mm LAMS might improve clinical outcomes. Hence, we conducted a study comparing the DPT and 20-mm LAMS in patients with large WON.DesignA single-centre, open-label, randomised, controlled superiority trial using an endoscopic step-up approach in patients with WON exceeding 15 cm in size. The primary endpoint was the number of necrosectomies needed to achieve clinical success (clinical and CT resolution), while the secondary endpoints included technical success, adverse events, length of stay and mortality.ResultsTwenty-two patients were included in the DPT group and 20 in the LAMS group, with no significant differences in patient characteristics. The median size of WON was 24.1 cm (P25–P75: 19.6–31.1). The technical success rates were 100% for DPT and 95% for LAMS (p=0.48), while clinical success rates were 95.5% and 94.7%, respectively (p=1.0). The mean number of necrosectomies was 2.2 for DPT and 3.2 for LAMS (p=0.42). Five patients (12%) developed procedure-related serious adverse events (DPT=4, LAMS=1, p=0.35). The median length of stay was 43 (P25–P75: 40–67) and 58 days (P25–P75: 40–86) in the DPT and LAMS groups (p=0.71), respectively, with an overall mortality of 4.8%.ConclusionsFor treating large WON, LAMS are not superior to DPT. The techniques are associated with comparable needs for necrosectomy and hospital stay, and no gross difference in adverse events.Trial registration numberNCT04057846.

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Section: Discussionmentioning

confidence: 99%

EUS-guided drainage of large walled-off pancreatic necroses using plastic versus lumen-apposing metal stents: a single-centre randomised controlled trial

Karstensen

Novovic

Hansen

et al. 2022

Gut

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“…These included but not limited to biliary drainage (EUS-guided choledochoduodenostomy and EUS-guided cholecystostomy), luminal bypass (EUS-guided gastroenterostomy), EUS-guided transmural drainage of PFCs (including walled off necrosis and pseudocysts), and for treatment of postsurgical fluid collections. [ 13 14 15 16 17 18 ] Table 5 shows a summary of these indications and their rates technical and clinical success as well as adverse events. Overall, AXIOS stent placement has been associated with high clinical and technical success with adverse events ranging from 4% to 22%, depending on the indication.…”

Section: Discussionmentioning

confidence: 99%

Adverse events associated with AXIOS stents: Insights from the manufacturer and user facility device experience database

Ramai¹,

Facciorusso²,

DeLuca³

et al. 2022

Endosc Ultrasound

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Background and Objectives: The AXIOS stent is indicated for transgastric or transduodenal drainage of symptomatic pancreatic pseudocysts and symptomatic walled off necrosis. The AXIOS stent functions as a conduit which allows solid and liquid pancreatic fluid collections (PFC) contents to pass into the luminal GI tract and also allows the passage of standard and therapeutic endoscopes into the PFC to perform endoscopic debridement. We aim to investigate the number and type of complications associated with AXIOS stents. Materials and Methods: We analyzed postmarketing surveillance data from the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database January 2016 to February 2021. Results: During the study period, approximately 588 reports with 579 device issues and 250 patient complications were identified. Most device complications were due to stent positioning problems or stent malpositioning ( n = 206; 35.6%), followed by stent migration ( n = 72; 12.4%), premature deployment ( n = 61; 10.5%), material integrity ( n = 56; 9.6%), deployment failure ( n = 47; 8.1%), and difficulty removing the stent ( n = 45; 7.7%). The most reported patient adverse events were hemorrhage/bleeding ( n = 81; 32.4%), perforation ( n = 26; 10.4%), pain ( n = 22; 8.8%), unspecified infection ( n = 20; 8.0%), and death ( n = 17; 6.8%). Conclusions: Findings from the MAUDE database highlight patient and device complications which endoscopists should be aware of before AXIOS stent placement.

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“…In conclusion, lumen-apposing stents seem to be preferable to plastic stents, but to date, there are no solid data in the literature to confirm this endoscopists’ choice. [ 68 69 70 ]…”

Section: Discussionmentioning

confidence: 99%

Controversies in EUS-guided treatment of walled-off necrosis

Hocke¹,

Burmeister²,

Braden³

et al. 2022

Endosc Ultrasound

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This review gives an overview of different techniques in the treatment of post-acute complications of acute pancreatitis. The endoscopic treatment of those complications is currently standard of care. EUS opened up the broad implementation of internal drainage methods to make them safe and effective. Due to different endoscopic approaches worldwide, controversies have arisen that are pointed out in this paper. The main focus was placed on weighing up evidence to find the optimal approach. However, if no evidence can be provided, the authors, experienced in the field, give their personal advice.

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Comparison Between Lumen-Apposing Metal Stents and Plastic Stents in Endoscopic Ultrasound–Guided Drainage of Pancreatic Fluid Collection

Cited by 19 publications

References 34 publications

EUS-guided drainage of large walled-off pancreatic necroses using plastic versus lumen-apposing metal stents: a single-centre randomised controlled trial

EUS-guided drainage of large walled-off pancreatic necroses using plastic versus lumen-apposing metal stents: a single-centre randomised controlled trial

Adverse events associated with AXIOS stents: Insights from the manufacturer and user facility device experience database

Controversies in EUS-guided treatment of walled-off necrosis

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