Impact of endoprosthesis type on inflammatory response in patients undergoing endoscopic drainage of pancreatic fluid collections

Abstract

ObjectiveTo study the impact of endoprosthesis type on inflammatory response in patients undergoing endoscopic ultrasound (EUS)‐guided drainage of pancreatic fluid collections (PFC).MethodsPatients undergoing EUS‐guided PFC drainage and treated using lumen‐apposing metal stents (LAMS) or plastic endoprostheses constituted the study cohort. The primary outcome was the presence of systemic inflammatory response syndrome (SIRS) after index intervention. Secondary outcomes were persistent organ failure, new onset organ failure, duration of hospitalization, and treatment success.ResultsIn all, 303 patients were treated using LAMS (n = 247) or plastic stents (n = 56). At 48 h postintervention, the presence of SIRS (25.0 vs. 14.2%, P = 0.047), new onset SIRS (10.0 vs. 1.8%, P = 0.017), and new organ failure (5.4 vs. 0.4%, P = 0.003) were significantly higher in the plastic stent cohort compared to LAMS. On multivariable logistic regression analysis, the use of plastic stents (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.2–6.0, P = 0.014), patients receiving high‐acuity care (OR 5.1, 95% CI 2.5–10.4, P < 0.001) and the presence of ≥33% of necrosis (OR 4.5, 95% CI 2.0–10.0, P < 0.001) were significantly associated with the presence of SIRS or new organ failure. While there was no significant difference in treatment success (96.4 vs. 95.5%, P = 0.77), duration of hospitalization was significantly longer for the plastic stent cohort (mean [standard deviation] 12.5 [17.8] vs. 7.9 [10.1] days, P = 0.009).ConclusionsUse of plastic stents as compared to LAMS was associated with a higher proportion of SIRS and new organ failure that prolonged hospital stay. Therefore, placement of LAMS is recommended in sick patients and those with ≥33% necrosis to minimize inflammatory response.

WONDER-02: plastic stent vs. lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic pseudocysts—study protocol for a multicentre randomised non-inferiority trial

“…In the WONDER-02 trial, the experimental intervention is EUS-guided transluminal placement of plastic stents for a pancreatic pseudocyst, and the control intervention is the placement of a LAMS. With the growing popularity of LAMSs in EUS-guided drainage of pancreatobiliary diseases including PFCs (17,31,32), this modality is currently used as a treatment option for large-size pancreatic pseudocysts at many centres. Compared to plastic stents, LAMSs may provide better drainage e ciency due to their large calibre.…”

Gastric leak closure after the misdeployment of a lumen-apposing metal stent

“…Endoscopic ultrasound-guided cystogastrostomy (EUS-CG) represents the main therapeutic modality for treatment of pancreatic fluid collections 1 2 . While much has been written regarding technical advantages of lumen-apposing metal stents (LAMSs), there are limited data on the complications, which range from 7 % to 15 % 3 4 .…”

Risk of recurrence with or without plastic stent after EUS-guided treatment of peripancreatic fluid collections: A systematic review and meta-analysis

“…When PFC is not resolved by drainage alone, endoscopic necrosectomy through the transmural fistula has been reported as an effective step-up method to achieve resolution, specifically in WON with abundant necrotic materials 5 6 7 8 9 10 . More recently, a lumen-apposing metallic stent (LAMS), which has a large caliber and allows endoscope passage, has made endoscopic necrosectomy more feasible and effective 11 12 13 14 . These developments in techniques and devices and the comprehension of disease pathology have made endoscopic transluminal drainage a more reliable and essential treatment for the management of PFCs.…”