The role of co-axially placed double-pigtail stents within lumen-apposing metal stents in draining pancreatic fluid collections

Abstract

Aburajab et al 1 reported their recent experience with lumen-apposing metal stents (LAMSs) in the treatment of pancreatic pseudocysts (PPs). They described a decreasing tendency in cyst cavity infection after placing double-pigtail stents (DPSs) across LAMSs compared with those without DPSs. Moreover, several centers reported their experience in DPS placement through LAMSs while draining walled-off necrosis (WON), and DPS was supposed to prevent occlusion by impacting necrotic tissue. 2-4 Because PPs have no necrotic component, the authors postulate that DPSs might play a role in holding back the large pieces of solid food material from entering the cavity, which may subsequently lead to infection.

Comparison of three different stents for endoscopic ultrasound‐guided drainage of pancreatic fluid collection: A large retrospective study

“…Therefore, when the rapid drainage of PFC (especially for drainage of the WON contents) is facilitated, undigested solid material can also easily enter the cyst cavity and cause stent occlusion or cavity infection. 26 Besides, as described in our recent published paper, 27 there is a fair possibility that the collapsed cyst wall could obstruct the distal flange (internal) of LAMS, as the large diameter of LAMS facilitates the rapid drainage of PFC cavity. Furthermore, PFC treated by LAMS was also reported to have a high rate of stent-related AEs including delayed bleeding, buried stent syndrome, and biliary stricture, 28 which were not common in PS group.…”

Comparative efficacy of stents in endoscopic ultrasonography‐guided peripancreatic fluid collection drainage: A systematic review and network meta‐analysis

“…Food clogging, which can lead to stent occlusion or secondary cystic infection, might frequently occur despite rapid drainage and resolution of PFC by LAMS . Another theory explaining the inferior success rate of LAMS is that a collapsed PFC wall may lead to obstruction of the internal opening within the distal flanges of the LAMS . In this regard, co‐axial placement of DPPS within LAMS is an attractive strategy for preventing secondary infection .…”

“…35 Another theory explaining the inferior success rate of LAMS is that a collapsed PFC wall may lead to obstruction of the internal opening within the distal flanges of the LAMS. 36 In this regard, co-axial placement of DPPS within LAMS is an attractive strategy for preventing secondary infection. [35][36][37] Although further exploration of the mechanism is needed, DPPS might play a role in holding back large amounts of food materials from entering the cavity through the larger diameter of the LAMS, which may subsequently lead to infection.…”

“…36 In this regard, co-axial placement of DPPS within LAMS is an attractive strategy for preventing secondary infection. [35][36][37] Although further exploration of the mechanism is needed, DPPS might play a role in holding back large amounts of food materials from entering the cavity through the larger diameter of the LAMS, which may subsequently lead to infection. Further, it could ensure stent patency by providing space because there is a possibility that the collapsed PFC wall could adhere to the inner flange of the LAMS.…”

Lumen-apposing metal stent acted as an interim role in walled-off necrosis drainage

“…Aburajab et al 7 reported that placing plastic stents across LAMS during drainage of pancreatic pseudocysts reduced the likelihood of postprocedure infection. A WON cavity with ‘two-way traffic’ helps debris exit even when the cyst wall has collapsed8 and may reduce the total cost of the procedure.…”