Safety and rate of delayed adverse events with lumen-apposing metal stents (LAMS) for pancreatic fluid collections: a multicenter study

Abstract

Background and study aims Endoscopic drainage with dedicated lumen-apposing metal stents (LAMS) is routinely performed for symptomatic pancreatic fluid collections (PFCs), walled-off necrosis (WON) and pseudocyst (PP). There has been increasing concern regarding delayed adverse events associated with the indwelling LAMS. Patients and methods Multicenter retrospective analysis of consecutive patients who underwent endoscopic ultrasound (EUS)-guided LAMS placement for PFC from January 2010 to May 2017. Main outcomes included: (1) resolution of the PFC, (2) rate of delayed adverse events at follow-up, and (3) predictors of treatment failure and delayed adverse events on logistic regression. Results A total of 122 patients (mean age 50.9 years, 68 % male) underwent LAMS insertion for 64 WON (98.4 %) and 58 PP (98.3 %). PFC mean size was 10.6 cm. PFC resolution was significantly lower for WON (62.3 %) vs. PP (96.5 %) ( P < 0.001) on imaging at a median of 4 weeks. Stent occlusion was identified in 18 (29.5 %) and 10 (17.5 %) patients with WON and PP, respectively ( P = 0.13). There were no cases of delayed bleeding or buried stent on follow-up endoscopy. Use of electrocautery-enhanced LAMS was the only factor associated with treatment failure of WON (OR = 13.2; 95 % ci: 3.33 – 51.82, P = 0.02) on logistic regression. There were no patient, operator, or procedure-related factors predictive of stent occlusion. Conclusions EUS-guided LAMS for PFC is associated with a low incidence of delayed adverse events. While nearly all PPs resolve at 4 weeks permitting LAMS removal shortly thereafter, many WON persist, with use of electrocautery-enhanced LAMS being the sole predictor of treatment failure.

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.…”

Comparative Outcomes of EUS-Guided Lumen-Apposing Mental Stents Drainage for Pancreatic Pseudocysts and Walled-off Necrosis: Case Series and Meta-Analysis

“…Although we found no statistical difference in postoperative infection between WON and PPC, the summary of RR on the postoperative infection may indicate that the potential risk in WON (9%) was 1.57 times (95%CI: 0.73-3.39) higher than PPC (2%). Yang et al 25 proposed that the assessment of the proportion of necrotic tissue in WON cases can accurately predict the clinical outcome of LAMS drainage and provide a reference for selecting the best clinical protocol, such as LAMS with DEN, LAMS with double plastic stents, and only LAMS.…”

“…Due to paucity of data about the use of DEN in both arms provided, a good comparison for the use of DEN was not performed. The included literature also reported LAMS placement combining with other reasonable endoscopic treatments based on the available clinical expertise, such as the double pigtail plastic stent placed coaxially in LAMS 25 , the double pigtail plastic stent replaced after the removal of LAMS 28 , nasal cyst drainage tube placement, endoscopic retrograde pancreatic drainage 21 and percutaneous catheter drainage 24,26 , which may have a contribution in the outcome of PFCs. Even with an inevitable effect of the above combination therapies, the clinical success rate of WON is still lower than that of PPC.…”

Recent innovations in therapeutic endoscopy for pancreatobiliary diseases

“…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. On the other hand, Bang et al performed comparative studies of LAMS and plastic stent implantation, and reported there was no difference in clinical outcomes.…”