BACKGROUND & AIMS: There have been few studies that compared the effects of lumen-apposing metal stents (LAMS) and double-pigtail plastic stents (DPS) in patients with peripancreatic fluid collections from pancreatitis. We aimed to compare technical and clinical success and adverse events in patients who received LAMS vs DPS for pancreatic pseudocysts and walled-off necrosis. METHODS: We performed a retrospective study of endoscopic ultrasound-mediated drainage in 149 patients (65% male; mean age, 47 y) with pancreatic pseudocysts or walled-off necrosis (97 received LAMS and 152 received DPS), from January 2011 through September 2016 at a single center. We collected data on patient characteristics, outcomes, hospitalizations, and imaging findings. Technical success was defined as LAMS insertion or a minimum of 2 DPS. Clinical success was defined as resolution of pancreatic pseudocysts or walled-off necrosis based on imaging results. The primary outcome was resolution of peripancreatic fluid collection with reduced abdominal pain or obstructive signs or symptoms. Secondary outcomes included the identification and management of adverse events, number of additional procedures required to resolve fluid collection, and the recurrence of fluid collection. RESULTS: Patients who received LAMS had larger peripancreatic fluid collections than patients who received DPS prior to intervention (P = .001), and underwent an average 1.7 interventions vs 1.9 interventions for patients who received DPS (P = .93). Technical success was achieved for 90 patients with LAMS (92.8%) vs 137 patients with DPS (90.1%) (odds ratio [OR] for success with DPS, 0.82; 95% CI, 0.33-2.0; P = .67). Despite larger fluid collections in the LAMS group, there was no significant difference in proportions of patients with clinical success following placement of LAMS (82 of 84 patients, 97.6%) vs DPS (118 of 122 patients, 96.7%) (OR for clinical success with DPS, 0.73; 95% CI, 0.13-4.0; P = .71). Adverse events developed in 24 patients who received LAMS (24.7%) vs 27 patients who received DPS (17.8%) (OR for an adverse event in a patient receiving a DPS, 0.82; 95% CI, 0.33-2.0; P = .67). However, patients with LAMS had a higher risk of pseudoaneurysm bleeding than patients with DPS (OR, 10.0; 95% CI, 1.19-84.6; P = .009). CONCLUSIONS: In a retrospective study of patients undergoing drainage of pancreatic pseudocysts or walled-off necrosis, we found LAMS and DPS to have comparable rates of technical and clinical success and adverse events. Drainage of walled-off necrosis or pancreatic pseudocysts using DPS was associated with fewer bleeding events overall, including pseudoaneurysm bleeding, but bleeding risk with LAMS should be weighed against the trend of higher actionable perforation and infection rates with DPS.
BACKGROUND & AIMS: There have been few studies that compared the effects of lumen-apposing metal stents (LAMS) and double-pigtail plastic stents (DPS) in patients with peripancreatic fluid collections from pancreatitis. We aimed to compare technical and clinical success and adverse events in patients who received LAMS vs DPS for pancreatic pseudocysts and walled-off necrosis. METHODS: We performed a retrospective study of endoscopic ultrasound-mediated drainage in 149 patients (65% male; mean age, 47 y) with pancreatic pseudocysts or walled-off necrosis (97 received LAMS and 152 received DPS), from January 2011 through September 2016 at a single center. We collected data on patient characteristics, outcomes, hospitalizations, and imaging findings. Technical success was defined as LAMS insertion or a minimum of 2 DPS. Clinical success was defined as resolution of pancreatic pseudocysts or walled-off necrosis based on imaging results. The primary outcome was resolution of peripancreatic fluid collection with reduced abdominal pain or obstructive signs or symptoms. Secondary outcomes included the identification and management of adverse events, number of additional procedures required to resolve fluid collection, and the recurrence of fluid collection. RESULTS:Patients who received LAMS had larger peripancreatic fluid collections than patients who received DPS prior to intervention (P = .001), and underwent an average 1.7 interventions vs 1.9 interventions for patients who received DPS (P = .93). Technical success was achieved for 90 patients with LAMS (92.8%) vs 137 patients with DPS (90.1%) (odds ratio [OR] for success with DPS, 0.82; 95% CI, 0.33-2.0; P = .67). Despite larger fluid collections in the LAMS group, there was no significant difference in proportions of patients with clinical success following placement of LAMS (82 of 84 patients, 97.6%) vs DPS (118 of 122 patients, 96.7%) (OR for clinical success with DPS, 0.73; 95% CI, 0.13-4.0; P = .71). Adverse events developed in 24 patients who received LAMS (24.7%) vs 27 patients who received DPS (17.8%) (OR for an adverse event in a patient receiving a DPS, 0.82; 95% CI, 0.33-2.0; P = .67). However, patients with LAMS had a higher risk of pseudoaneurysm bleeding than patients with DPS (OR, 10.0; 95% CI, 1.19-84.6; P = .009). CONCLUSIONS: In a retrospective study of patients undergoing drainage of pancreatic pseudocysts or walled-off necrosis, we found LAMS and DPS to have comparable rates of technical and clinical success and adverse events. Drainage of walled-off necrosis or pancreatic pseudocysts using DPS was associated with fewer bleeding events overall, including pseudoaneurysm bleeding, but bleeding risk with LAMS should be weighed against the trend of higher actionable perforation and infection rates with DPS.
Authors: Raj J Shah; Janak N Shah; Irving Waxman; Thomas E Kowalski; Andres Sanchez-Yague; Jose Nieto; Brian C Brauer; Monica Gaidhane; Michel Kahaleh Journal: Clin Gastroenterol Hepatol Date: 2014-10-05 Impact factor: 11.382
Authors: Olaf J Bakker; Hjalmar C van Santvoort; Sandra van Brunschot; Ronald B Geskus; Marc G Besselink; Thomas L Bollen; Casper H van Eijck; Paul Fockens; Eric J Hazebroek; Rian M Nijmeijer; Jan-Werner Poley; Bert van Ramshorst; Frank P Vleggaar; Marja A Boermeester; Hein G Gooszen; Bas L Weusten; Robin Timmer Journal: JAMA Date: 2012-03-14 Impact factor: 56.272
Authors: Emanuele Rinninella; Rastislav Kunda; Markus Dollhopf; Andres Sanchez-Yague; Uwe Will; Ilaria Tarantino; Joan Gornals Soler; Sebastian Ullrich; Alexander Meining; Josè Miguel Esteban; Thomas Enz; Geoffroy Vanbiervliet; Frank Vleggaar; Fabia Attili; Alberto Larghi Journal: Gastrointest Endosc Date: 2015-05-23 Impact factor: 9.427
Authors: Ali A Siddiqui; Thomas E Kowalski; David E Loren; Ammara Khalid; Ayesha Soomro; Syed M Mazhar; Laura Isby; Michel Kahaleh; Kunal Karia; Joseph Yoo; Andrew Ofosu; Beverly Ng; Reem Z Sharaiha Journal: Gastrointest Endosc Date: 2016-08-24 Impact factor: 9.427
Authors: Sandra van Brunschot; Janneke van Grinsven; Hjalmar C van Santvoort; Olaf J Bakker; Marc G Besselink; Marja A Boermeester; Thomas L Bollen; Koop Bosscha; Stefan A Bouwense; Marco J Bruno; Vincent C Cappendijk; Esther C Consten; Cornelis H Dejong; Casper H van Eijck; Willemien G Erkelens; Harry van Goor; Wilhelmina M U van Grevenstein; Jan-Willem Haveman; Sijbrand H Hofker; Jeroen M Jansen; Johan S Laméris; Krijn P van Lienden; Maarten A Meijssen; Chris J Mulder; Vincent B Nieuwenhuijs; Jan-Werner Poley; Rutger Quispel; Rogier J de Ridder; Tessa E Römkens; Joris J Scheepers; Nicolien J Schepers; Matthijs P Schwartz; Tom Seerden; B W Marcel Spanier; Jan Willem A Straathof; Marin Strijker; Robin Timmer; Niels G Venneman; Frank P Vleggaar; Rogier P Voermans; Ben J Witteman; Hein G Gooszen; Marcel G Dijkgraaf; Paul Fockens Journal: Lancet Date: 2017-11-03 Impact factor: 79.321
Authors: Laura González-González; Sergio Bazaga; Marianette Murzi; Anna Brujats; Mireia Trias; Beatriz de Riba; Raffaella Romito; Juan Colán-Hernández; Mar Concepción; Jordi Gordillo; Juan Carlos Pernas; Maria Poca; German Soriano; Carlos Guarner-Argente Journal: Surg Endosc Date: 2021-03-03 Impact factor: 4.584
Authors: Ji Young Bang; C Mel Wilcox; Juan Pablo Arnoletti; Shajan Peter; John Christein; Udayakumar Navaneethan; Robert Hawes; Shyam Varadarajulu Journal: Dig Endosc Date: 2021-09-06 Impact factor: 6.337