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CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(03): E347-E354
DOI: 10.1055/a-0828-7630
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Lumen apposing metal stents are superior to plastic stents in pancreatic walled-off necrosis: a large international multicenter study

Yen-I Chen
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
15   Division of Gastroenterology and Hepatology, McGill University Health Center, McGill University, Montreal, QC, Canada
,
Juliana Yang
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Shai Friedland
 2   Division of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA
,
Ian Holmes
 2   Division of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA
,
Ryan Law
 3   Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
,
Amy Hosmer
 3   Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
,
Tyler Stevens
 4   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
,
Matheus C. Franco
 4   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
,
Sunguk Jang
 4   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
,
Rishi Pawa
 5   Division of Gastroenterology and Hepatology, Wake Forest School of Medicine, Winston Salem, NC, USA
,
Nihar Mathur
 5   Division of Gastroenterology and Hepatology, Wake Forest School of Medicine, Winston Salem, NC, USA
,
Divyesh V. Sejpal
 6   Division of Gastroenterology, Hofstra Northwell School of Medicine, Northwell Health System, Manhasset, NY, USA
,
Sumant Inamdar
 6   Division of Gastroenterology, Hofstra Northwell School of Medicine, Northwell Health System, Manhasset, NY, USA
,
Arvind J. Trindade
 6   Division of Gastroenterology, Hofstra Northwell School of Medicine, Northwell Health System, Manhasset, NY, USA
,
Jose Nieto
 7   Division of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, FL, USA
,
Tyler M. Berzin
 8   Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
,
Mandeep Sawhney
 8   Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
,
Michael L. DeSimone
 8   Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
,
Christopher DiMaio
 9   Division of Gastroenterology and Hepatology, Mount Sinai, New York, NY, USA
,
Nikhil A. Kumta
 9   Division of Gastroenterology and Hepatology, Mount Sinai, New York, NY, USA
,
Sanchit Gupta
 9   Division of Gastroenterology and Hepatology, Mount Sinai, New York, NY, USA
,
Patrick Yachimski
10   Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University, Nashville, TN, USA
,
Andrea Anderloni
11   Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
,
Todd H. Baron
12   Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
,
Theodore W. James
12   Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
,
Laith H. Jamil
13   Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, CA, USA
,
Mel A. Ona
13   Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, CA, USA
,
Simon K. Lo
13   Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, CA, USA
,
Srinivas Gaddam
13   Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, CA, USA
,
Markus Dollhopf
14   Division of Gastroenterology and Hepatology, Klinikum Neuperlach, Munich, Germany
,
Majidah A. Bukhari
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Robert Moran
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Olaya Brewer Gutierrez
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Omid Sanaei
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Lea Fayad
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Saowanee Ngamruengphong
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Vivek Kumbhari
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Vikesh Singh
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Alessandro Repici
12   Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
,
Mouen A. Khashab
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
› Author Affiliations
Further Information

Publication History

submitted 05 March 2018

accepted after revision 31 July 2018

Publication Date:
28 February 2019 (online)

Also available at
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Abstract

Background and study aims The use of lumen apposing metal stents (LAMS) during EUS-guided transmural drainage (EUS-TD) of pancreatic walled-off necrosis (WON) has gained popularity. Data supporting their use in WON over plastic stents (PS), however, remain scarce. The aim of this study was to compare the clinical efficacy of LAMS (Axios, Boston Scientific) with PS in WON.

Patients and methods This was a multicenter, retrospective study involving 14 centers. Consecutive patients who underwent EUS-TD of WON (2012 – 2016) were included. The primary end point was clinical success defined as WON size ≤ 3 cm within a 6-month period without need for percutaneous drainage (PCD) or surgery.

Results A total of 189 patients (mean age 55.2 ± 15.6 years, 34.9 % female) were included (102 LAMS and 87 PS). Technical success rates were similar: 100 % in LAMS and 98.9 % in PS (P = 0.28). Clinical success was attained in 80.4 % of LAMS and 57.5 % of PS (P = 0.001). Rate of PCD was similar (13.7 % LAMS vs. 16.3 % PS, P = 0.62), while PS was associated with a greater need for surgery (16.1 % PS vs. 5.6 % LAMS, P = 0.02). Adverse events (AEs) were observed in 9.8 % of LAMS and 10.3 % of PS (P = 0.90) and were rated as severe in 2.0 % and 6.9 %, respectively (P = 0.93). After excluding patients with < 6 months follow-up, the rate of WON recurrence following initial clinical success was greater with PS (22.9 % PS vs. 5.6 % LAMS, P = 0.04).

Conclusions When compared to PS, LAMS in WON is associated with higher clinical success, shorter procedure time, lower need for surgery, and lower rate of recurrence.

Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2019; 51(04): 392-392
DOI: 10.1055/a-0843-3002

 

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