Safety and efficacy of early versus late removal of LAMS for pancreatic fluid collections

Abstract

Background and Study Aims: Optimal timing for removal of lumen-apposing metal stents (LAMS) for effective drainage of pancreatic fluid collections (PFC) while minimizing adverse events (AE) is unknown. Outcomes of early (≤ 4 weeks) or delayed (> 4 weeks) LAMS removal on both clinical efficacy and the incidence of AE were assessed. Patients and methods: This is a retrospective analysis of a prospectively maintained registry of PFC drainage between November 2016 and September 2021. Clinical success was defined as a 75% decrease in fluid collection volume, with no need for reintervention at 6 months. AE were defined using ASGE lexicon. Multiple logistic regression analysis was performed to determine variables associated with clinical success and AE. Results: 108 consecutive PFC were included. LAMS deployment was technically successful in 103/108 (95.4%) of cases. Failure was associated with collection diameter ≤4 cm (OR 24.0, p=0.005) and presence of more than 50% necrotic material (OR 20.1, p=0.01). Stents were left in place for a median of 48 days. Patients with early stent removal (< 4 weeks) had clinical success in 70.0% of cases, which was significantly less than in the group with delayed stent removal (96.4%, p=0.03). On multiple regression analysis, clinical failure was associated with early stent removal (OR 25.5, p=0.003). AE occurred in 8.7% of cases (9/103). There were no predictors of AE. Notably, delayed stent removal did not predict the occurrence of AE. Conclusions: Early LAMS removal (<4 weeks) did not prevent AE but did lead to increased clinical failure.

Reply to Saito et al

“…We would like to thank Saito T and colleagues for their comments about and interest in our study about the timing of lumen-apposing metal stent (LAMS) removal during endoscopic ultrasound-guided treatment of pancreatic fluid collections (PFCs) 1 . We agree with the authors that a better understanding of which PFCs will require longer LAMS placement is needed to optimize patient care.…”