No Advantage of Lumen-Apposing Metal Stents over Double-Pigtail Plastic Stents for Endoscopic Treatment of Infected Necrotizing Pancreatitis

Aims The endoscopic step-approach is preferred over a surgical step-up approach in eligible patients with infected necrotizing pancreatitis. Lumen-apposing metal stents (LAMS) might optimize endoscopic drainage and reduce the need for endoscopic necrosectomy. Nevertheless, some safety concerns, particularly bleeding, remain. We conducted a multicenter prospective study to investigate the clinical outcome of LAMS in patients with infected necrotizing pancreatitis.

Methods Patients with infected necrotizing pancreatitis, eligible for endoscopic drainage with LAMS, were prospectively enrolled and compared to 51 patients assigned to the endoscopic step-up approach with double-pigtail plastic stents (DPS) in the multicenter TENSION trial. Primary endpoint was the need for endoscopic necrosectomy. Secondary endpoints included mortality, major complications, total number of interventions, length of intensive care and hospital stay during 6 months of follow-up.

Results A total of 53 patients were prospectively enrolled in 17 hospitals. The primary end point did not differ between the LAMS-group and DPS-group (64 % vs. 57 %; RR 1.13, 95 %CI 0.83-1.54, P = 0.55). After correction for age, gender, SIRS, CRP, and use of antibiotics, the odds of endoscopic necrosectomy was 1.14 (95 %CI 0.44-2.90, P = 0.78).

No differences were observed in mortality (11 % vs. 18 %; RR 0.64, 95 %CI 0.25-1.67, P =  0.41) or major complications. Bleeding occurred in 9 % in the LAMS vs. 22 % in the DPS-group (RR 0.44, 95 %CI 0.16-1.17, P = 0.11). Length of intensive care stay was equal (median 0 days vs. 0 days, P = 0.49), and hospital stay did not differ (median 34 days vs. median 35, P = 0.23). The median number of drainage procedures was 1 in the LAMS-group vs. 1 in the DPS-group (P = 0.44), and median number of necrosectomies was 1 vs. 1 (P = 0.37).

Conclusions In patients with infected necrotizing pancreatitis, the use of LAMS for endoscopic drainage was not superior to DPS with regards to need for endoscopic necrosectomy. No increased risk of major complications, in particular bleeding, was found.

Citation: Boxhoorn L, Verdonk RC, Besselink MG et al. OP2 NO ADVANTAGE OF LUMEN-APPOSING METAL STENTS OVER DOUBLE-PIGTAIL PLASTIC STENTS FOR ENDOSCOPIC TREATMENT OF INFECTED NECROTIZING PANCREATITIS. Endoscopy 2021; 53: S5.

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Artikel online veröffentlicht:
19. März 2021