Peripancreatic fluid collections, plastic stents, and different sub-types of metal stents: Where does the evidence land?

Abstract

Background: Peripancreatic fluid collections (PFCs) are a frequent complication of acute pancreatitis. Symptomatic PFCs may need to be drained, and there are multiple endoscopic accessories that can facilitate the procedure. This paper aims to compare the success rate, number of procedures required for resolution and adverse events rate for PFCs EUS-guided drainage with plastic stents and lumen-apposing metal stents (LAMS). Methods: This is a retrospective analysis of a consecutive sample of patients that was collected from 2013 – 2019. The medical records of these patients were reviewed, and the outcomes for each type of stent (plastic vs LAMS, and different subtypes of LAMS) were compared in terms of clinical success, number of re-interventions needed, and adverse events. Results: A total of 33 patients (23 males) were treated for PFCs with EUS-guided drainage and stenting. The patients' ages ranged between 14 and 85 years (mean ± SD: 43.5 ± 19 years). Overall, there was no difference between plastic stents and LAMS in terms of symptomatic recovery ( P = 0. 24), but metal stents had better results with regards to radiological resolution ( P = 0.03), and were associated with a higher number of necrosectomies ( P = 0.029). Adverse events occurred more frequently in patients who had plastic stents, but direct comparison between the two groups showed that the difference was not statistically significant ( P = 0.2). Stratification for different LAMS subtypes showed no difference in terms of symptomatic or radiological resolution ( P =0.49), number of rescue procedures ( P = 0.41), and adverse events ( P = 0.81). Conclusion: Our study, along with the current available evidence, suggests a slight advantage of metal stents over plastic stents in terms of clinical success, need for rescue procedures, and incidence of adverse events. Furthermore, it provides empirical evidence that the different sub-types of LAMS perform similarly when compared against each other.

Safety and efficacy of lumen-apposing metal stents and double-pigtail plastic stents for endoscopic ultrasound-guided drainage of walled-off necrosis; a systematic review and meta-analysis

“…Two RCTs [ 20 , 21 ] and thirteen observational studies [ 22–34 ] compared the LAMS/BFMS and DPS outcomes of patients with WON. Seven studies were carried out in the USA [ 20 , 22–24 , 29 , 30 , 34 ], three in India [ 27 , 28 , 33 ] and one each in Japan [ 26 ], Saudi Arabia [ 25 ], Sweden [ 31 ], the Netherlands [ 21 ] and China [ 32 ]. Tables 1 and 2 display all study characteristics.…”

Current status of treatments of pancreatic and peripancreatic collections of acute pancreatitis

“…Additionally, the matched cautery-enhanced delivery systems decrease technical difficulty and shorten the procedural time. Even though some studies show LAMS might have a slight advantage over plastic stents in terms of clinical success[ 27 , 59 , 60 ], more studies have shown that there were no differences between LAMS and plastic stents regarding the technical success rate, clinical success, recurrence in drainage of pancreatic, and peripancreatic collections[ 24 , 25 , 60 - 62 ]. In contrast, the bleeding risk (including pseudoaneurysm bleeding, which is life-threatening and may require immediate interventional radiology-guided coil embolization or open surgery) is higher in the LAMS group[ 32 , 61 , 62 ].…”

EUS-guided interventional therapies for pancreatic diseases

“…Moreover, LAMS provides a larger diameter that facilitates direct endoscopic necrosectomy (13). Considering the aforementioned advantages, LAMS has emerged as the preferred stent choice for endoscopic drainage among a significant number of gastroenterologists (14)(15)(16). Although possessing notable advantages, LAMS exhibits certain limitations.…”