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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(12): E1153-E1160
DOI: 10.1055/a-2197-3731
Original article

Analysis of adverse events with lumen apposing metal stents for drainage of pancreatic fluid collections

Rishi Pawa 
1   Gastroenterology, Wake Forest University School of Medicine, Winston-Salem, United States (Ringgold ID: RIN12279)
,
Robert Dorrell
1   Gastroenterology, Wake Forest University School of Medicine, Winston-Salem, United States (Ringgold ID: RIN12279)
,
Madison Nguyen
2   Department of Medicine, Virginia Commonwealth University, Richmond, United States (Ringgold ID: RIN6889)
,
Greg Russell
3   Biostatistics, Wake Forest University School of Medicine, Winston-Salem, United States (Ringgold ID: RIN12279)
,
John Gilliam
1   Gastroenterology, Wake Forest University School of Medicine, Winston-Salem, United States (Ringgold ID: RIN12279)
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Abstract

Background and study aims Innovations in endoscopic management of pancreatic fluid collections (PFCs) using lumen apposing metal stents (LAMS) have rendered it a preferred approach for drainage of PFCs. These advances have not come without concern for adverse events (AEs). We present our experience with LAMS for drainage of PFCs and analyze factors that contribute to LAMS-related AEs.

Patients and methods From November 2015 to October 2021, a retrospective analysis was performed of patients undergoing endoscopic management of PFCs using LAMS. All AEs were classified as either early (<48 hours) or late (>48 hours). Univariate and multivariate analysis were performed using logistic regression to assess the relationship between independent variables and AEs.

Results A total of 119 patients with symptomatic PFCs underwent endoscopic drainage with LAMS. There were 16 AEs (12.4%). These included systemic inflammatory response syndrome (SIRS) (n=2), stent occlusion (n=5), bleeding (n=7), and stent migration (n=2). Univariate analysis of risk of AEs showed that no variables approached statistical significance. Of the seven patients who developed bleeding, five had pseudoaneurysms following LAMS placement and underwent angioembolization by an interventional radiologist. The average time to bleeding was 9.3 days (standard deviation 7.3) with all bleeding events occurring within 3 weeks. In a multivariate model, pseudocysts and presence of paracolic gutter extension were associated with an increased risk of bleeding.

Conclusions Endoscopists should be aware of the risk factors for LAMS-related bleeding and tailor their drainage strategy, including utilization of plastic stents for drainage of pseudocysts and adherence to a strict imaging interval and follow-up protocol.

Keywords

Pancreas - Endoscopic ultrasonography - Intervention EUS - Quality and logistical aspects - GI radiology


Publication History

Received: 29 July 2023

Accepted after revision: 19 October 2023

Article published online:
12 December 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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