Lumen apposing metal stents are superior to plastic stents in pancreatic walled-off necrosis: a large international multicenter study

Abstract

Background and study aims The use of lumen apposing metal stents (LAMS) during EUS-guided transmural drainage (EUS-TD) of pancreatic walled-off necrosis (WON) has gained popularity. Data supporting their use in WON over plastic stents (PS), however, remain scarce. The aim of this study was to compare the clinical efficacy of LAMS (Axios, Boston Scientific) with PS in WON. Patients and methods This was a multicenter, retrospective study involving 14 centers. Consecutive patients who underwent EUS-TD of WON (2012 – 2016) were included. The primary end point was clinical success defined as WON size ≤ 3 cm within a 6-month period without need for percutaneous drainage (PCD) or surgery. Results A total of 189 patients (mean age 55.2 ± 15.6 years, 34.9 % female) were included (102 LAMS and 87 PS). Technical success rates were similar: 100 % in LAMS and 98.9 % in PS (P = 0.28). Clinical success was attained in 80.4 % of LAMS and 57.5 % of PS (P = 0.001). Rate of PCD was similar (13.7 % LAMS vs. 16.3 % PS, P = 0.62), while PS was associated with a greater need for surgery (16.1 % PS vs. 5.6 % LAMS, P = 0.02). Adverse events (AEs) were observed in 9.8 % of LAMS and 10.3 % of PS (P = 0.90) and were rated as severe in 2.0 % and 6.9 %, respectively (P = 0.93). After excluding patients with < 6 months follow-up, the rate of WON recurrence following initial clinical success was greater with PS (22.9 % PS vs. 5.6 % LAMS, P = 0.04). Conclusions When compared to PS, LAMS in WON is associated with higher clinical success, shorter procedure time, lower need for surgery, and lower rate of recurrence.

What is the Impact of the Proportion of Solid Necrotic Content on the Number of Necrosectomies during EUS-Guided Drainage using Lumen-Apposing Metallic Stents of Pancreatic Walled-off Necrosis ?

“…Clinical success was defined as symptom resolution and WON resolution (<3 cm diameter), without mortality or adverse events requiring surgery, without the recurrence of fluid collection or symptoms during follow-up [12]. Need for surgery was defined as surgical intervention (minimally invasive or open) for management of unresolved WON or related complications (multisystem organ failure [MSOF], stent dislodgement with symptomatic pneumoperitoneum, untreatable infection, or intraabdominal bleeding).…”

Recent innovations in therapeutic endoscopy for pancreatobiliary diseases

“…Furthermore, the rate of early adverse events (AEs) was significantly lower in the FCSEMS group than the DP and LAMS groups; and the rate of delayed AEs was significantly lower in the LAMS group than the DP and FCSEMS groups. Chen et al 12 similarly found that groups in which plastic stents and LAMSs were used for treating WON showed no difference in the AEs rate, but the clinical success rate was significantly higher in the group in which LAMSs were used. In addition, Yang et al 13 evaluated delayed AEs when drainage using LAMSs was performed with WON and PPCs and found that stent occlusion in 18 (29.5%) and 10 (17.5%) patients, respectively, with no cases of delayed bleeding or buried stent being found by followup endoscopy.…”

“…Furthermore, the rate of early adverse events (AEs) was significantly lower in the FCSEMS group than the DP and LAMS groups; and the rate of delayed AEs was significantly lower in the LAMS group than the DP and FCSEMS groups. Chen et al . similarly found that groups in which plastic stents and LAMSs were used for treating WON showed no difference in the AEs rate, but the clinical success rate was significantly higher in the group in which LAMSs were used.…”

Endoscopic Management of Pancreatic Fluid Collections: An Update

“…In a large, multicenter study including 189 patients with WON, the use of LCMS was associated with higher clinical success (80.4 vs. 57.5%), shorter procedure time, lower need for surgery (5.1 vs. 16.1%), and lower rate of recurrence as compared to plastic stents [31]. However, the superiority of LCMS is not uniform across the published studies.…”