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CC BY 4.0 · Endoscopy
DOI: 10.1055/a-2307-7123
Original article

Impact of long-term transmural plastic stents on recurrence after endoscopic treatment of walled-off pancreatic necrosis

David M de Jong 
1   Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
Pauline M. C. Stassen 
1   Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
Ivo G. Schoots 
2   Radiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
Robert C. Verdonk 
3   Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, Netherlands
,
Marco J. Bruno 
1   Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
Rogier P. Voermans  ‡
4   Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, Netherlands
,
Pieter Jan F. de Jonge‡
1   Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
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Abstract

Background Endoscopic transmural drainage (ETD) using double-pigtail stents (DPSs) is a well-established treatment for walled-off pancreatic necrosis (WON). This study aimed to compare outcomes in patients undergoing ETD with DPSs left indwelling versus those where stents were removed or migrated.

Methods This retrospective multicenter cohort study included patients with WON who underwent ETD using DPSs between July 2001 and December 2019. The primary outcome was recurrence of a pancreatic fluid collection (PFC). Secondary outcomes were long-term complications and recurrence-associated factors. Competing risk regression analysis considered DPS removal or migration as time-varying covariates.

Results Among 320 patients (median age 58; 36% women), DPSs were removed in 153 (47.8%), migrated spontaneously in 27 (8.4%), and remained indwelling in 140 (43.8%). PFC recurrence was observed in 57 patients (17.8%): after removal (n = 39; 25.5%); after migration (n = 4; 14.8%); in patients with indwelling DPSs (n = 14; 10.0%). In 25 patients (7.8%), drainage of recurrent PFC was indicated. Risk factors for recurrence were DPS removal or migration (hazard ratio [HR] 3.45, 95%CI 1.37–8.70) and presence of a disconnected pancreatic duct (HR 5.08, 95%CI 1.84–14.0).

Conclusions Among patients who undergo ETD of WON, leaving DPSs in situ seems to lower the risk of recurrent fluid collections, without any long-term DPS-related complications. These results suggest that DPSs should not be routinely removed and can be safely left indwelling indefinitely.

Supplementary Material



Publication History

Received: 27 August 2023

Accepted after revision: 16 April 2024

Accepted Manuscript online:
16 April 2024

Article published online:
29 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
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