Endoscopic ultrasound-guided pancreatic pseudocyst drainage with lumen-apposing metal stents or plastic double-pigtail stents: A multifactorial analysis

Abstract

Objective: To compare the efficiency of plastic and metal stents for symptomatic pancreatic pseudocyst (PP) drainage and analyze other main associated factors that affect the outcome of drainage therapy. Method: Rates of technical and clinical success, procedure-related side effects (hemorrhage, stent migration, and cyst rupture), reinterventions, and duration of hospital stay. Results: There were 52 patients, 40 patients underwent plastic stent placement and 12 patients underwent lumen-apposing metal stent (LAMS) placement. The total rate of technical success was 100%. The total rate of clinical success was 100%. The total rate of adverse events was 7.7% (4/52). On multiple logistic regression analysis, the use of plastic stents (P < 0.05, Exp B = 12.168) and the presence of a large cyst (P < 0.05, Exp B = 1.036) were shown to significantly increase the risk of reintervention. On multivariate linear regression analysis, etiology of pseudocyst (P < 0.05, B = −8.427, −9.785, −5.514) was associated with prolonged hospital stent, while stent type was not shown be a factor (P > 0.05). Conclusion: Both plastic and LAMSs are proven to be highly efficient in PP drainage. The LAMS is superior in preventing complications such as migration and cyst leakage and reducing the rate of reintervention.

Lumen-apposing stents versus plastic stents in the management of pancreatic pseudocysts: a large, comparative, international, multicenter study

“…All these studies [20, 29, 31, 36 -38] included small numbers of LAMS patients treated with the AXIOS stent for pseudocysts (collectively a total of 60), as most had a mix of both WON and pancreatic pseudocyst collections (all but one study [20]), or a different type of LAMS (NAGI) that is not available in the USA had been used [29]. Ge et al [20] specifically compared LAMSs vs. DPPSs in the drainage of only pancreatic pseudocysts and showed DPPSs are associated with increased risk of re-intervention and increased migration and cyst leakage. The paucity of literature on this topic may be a contributor to the conflicting conclusions with regard to stent type for pancreatic pseudocyst management.…”

Are Lumen-Apposing Metal Stents More Effective Than Plastic Stents for the Management of Pancreatic Fluid Collections: An Updated Systematic Review and Meta-analysis

“…Our literature searches led to the identification of 1400 articles. After screening the titles and abstracts, 20 studies were found to meet our eligibility criteria ( Figure 1) [3,9,10,[12][13][14][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. A total of 1534 patients were included.…”

“…Owing to its larger diameter and its biflanged wide lumen, the LAMS is less likely to cause occlusion, thus reducing the need for repetitive stent alterations. A number of studies have since shown that LAMS provides an excellent tool for PFC drainage and has several clinical advantages over plastic stents [9,10]. Most recently, a meta-analysis conducted by Hammad et al in 2017 2.3.…”

Adenomyoma of the distal common bile duct demonstrated by endoscopic ultrasound: A case report and review of the literature

“…If such was diagnosed definitively as adenomyoma, endoscopic treatments like drainage or local resection should be performed, as they carry less risk for complications than the radical surgical procedure[5,6]. Meanwhile, the method of EUS-guided biliary drainage might be a primary alternative in patients with malignant obstruction[29,30].…”