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Safety and Efficacy of Lumen-Apposing Metal Stents With and Without Coaxial Plastic Stents for Pancreatic Fluid Collections

2022; Elsevier BV; Volume: 25; Issue: 2 Linguagem: Inglês

10.1016/j.tige.2022.12.001

2666-5107

James D. Haddad, Thomas Tielleman, Andrew Fuller, Anna Tavakkoli, Dutch Vanderveldt, Markus Goldschmiedt, Nisa Kubiliun, Tarek Sawas,

Gallbladder and Bile Duct Disorders

Abstract Background and Aims : Pancreatic fluid collections (PFCs) are common complications of acute pancreatitis and can cause pain, difficulty feeding, and infection. Endoscopic ultrasound (EUS)-guided drainage has become the standard of care, with lumen-apposing metal stents (LAMS) replacing double pigtail plastic stents (DPPS) as the preferred device. Coaxial placement of DPPS through LAMS is hypothesized to lower the risks of adverse events related to LAMS. We conducted a retrospective study to evaluate the safety and efficacy of this strategy. Methods : We conducted a retrospective study of consecutive patients with PFCs undergoing endoscopic cystgastrostomy with LAMS and DPPS or LAMS alone at two U.S. academic tertiary care centers from January 2016 until November 2022. Propensity scoring and an adjusted logistic regression model were used for analysis. Results : We included 68 patients with an average follow-up of 189 days. The most common etiology of pancreatitis was gallstones (35.3%), most PFCs were walled-off necrosis (61.8%), and the mean size was 14.7 cm (SD, ± 5.9 cm). Overall clinical success was 88.2%, without significant differences between LAMS and DPPS versus LAMS alone (95.7% vs. 84.4%, p=0.18; aOR 4.6, 95% CI 0.5-41.4). We found no statistically significant differences in rates of LAMS occlusion (aOR 0.47, 95% CI: 0.09-2.5), infection (aOR 1.03, 95% CI 0.17-6.2), bleeding (aOR 0.4, 95% CI 0.03-5), or stent migration (aOR 0.42, 95% CI 0.04-4.1) between the two groups. Conclusion : This retrospective cohort study found no statistically significant differences in the safety or efficacy of cystgastrostomy with LAMS and DPPS versus LAMS alone. Larger, prospective trials comparing these strategies are needed.