International, Multicenter Retrospective Trial Comparing the Efficacy and Safety of Bi-flanged Versus Lumen-apposing Metal Stents for Endoscopic Drainage of Walled-off Pancreatic Necrosis

Overview

Journal Ann Gastroenterol

Specialty Gastroenterology

Date 2021 Mar 3

PMID 33654370

Citations 8

Authors

Ali Siddiqui

Mariam Naveed

Jahangeer Basha

Sundeep Lakhtakia

Jose Nieto

Janak Shah

Kenneth Binmoeller

Megan Murphy

Rupjyoti Talukdar

Mohan K Ramchandani

Zaheer Nabi

Rajesh Gupta

Thomas E Kowalski

David E Loren

Reem Z Sharaiha

Michel Kahaleh

Patrick Ten Eyck

Arish Noor

Tayebah Mumtaz

Rakesh Kalalala

Nageshwar D Reddy

Douglas G Adler

Affiliations

Soon will be listed here.

Abstract

Background: To compare fully covered bi-flanged metal stents (BFMS) and lumen-apposing metal stents (LAMS) for endoscopic ultrasound (EUS)-guided drainage/debridement of pancreatic walled-off necrosis (WON).

Methods: Patients with WON managed by EUS-guided therapy were divided into those who underwent: 1) drainage using BFMS; and 2) drainage using LAMS and scheduled direct endoscopic necrosectomy (DEN). Clinical success (resolution of the WON), technical success (successful stent placement), and adverse events (AEs) were evaluated.

Results: 387 patients underwent WON endoscopic drainage, 205 using BFMS and 182 using LAMS. The clinical success in the BFMS or LAMS groups were similar (197 [96.1%] vs. 174 [95.6%]; P=0.81). Median number of procedures required for WON resolution was significantly lower in BFMS compared to LAMS (2 vs. 3, P<0.001). Technical success for stent placement was similar in BFMS and LAMS groups (203 [99%] vs. 180 [99%], P=0.90). Procedure-related AEs were similar in the BFMS and LAMS groups (19 [9.3%] vs. 20 [10.9%], P=0.61). Stent dysfunction with occluding debris was higher in the BFMS group compared to LAMS group (21 [10.2 %] vs. 11 [5.9%], P=0.04). The migration rate was higher in the BFMS group than in the LAMS group (15 [7.3%] vs. 3 [1.6%]; P<0.001). DEN was required in 23 [11.2%] patients in the BFMS group after lack of WON resolution by conservative means.

Conclusion: BFMS with a "step-up approach" and LAMS with scheduled DEN are both safe and effective for EUS-guided drainage/debridement of WON.

Citing Articles

Efficacy and Safety of Endoscopic Ultrasound (EUS)-Guided Lumen-Apposing Metal Stents (LAMS) as a Primary Treatment for Walled-Off Pancreatic Necrosis.

Mehta V, Gupta Y, Gupta A, Kumar Y, Khubber M, Sood A Cureus. 2025; 17(1):e78177.

PMID: 40026971 PMC: 11869351. DOI: 10.7759/cureus.78177.

Infected pancreatic necrosis-Current trends in management.

Shah J, Fernandez Y Viesca M, Jagodzinski R, Arvanitakis M Indian J Gastroenterol. 2024; 43(3):578-591.

PMID: 38625518 DOI: 10.1007/s12664-023-01506-w.

Lumen-apposing metal stents versus traditional self-expanding metal stents for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a systematic review and meta-analysis.

Tian Y, Yin C, Ma Y, Fu G, Liu R, Ran H Surg Endosc. 2023; 38(2):586-596.

PMID: 38151677 DOI: 10.1007/s00464-023-10636-3.

Mishaps with EUS-guided lumen-apposing metal stents in therapeutic pancreatic EUS: Management and prevention.

Braden B, Hocke M, Selvaraj E, Kaushal K, Moller K, Ignee A Endosc Ultrasound. 2023; 12(5):393-401.

PMID: 37969170 PMC: 10631618. DOI: 10.1097/eus.0000000000000018.

Endoscopic ultrasound drainage of pancreatic fluid collections: do we know enough about the best approach?.

Seicean A, Pojoga C, Rednic V, Hagiu C, Seicean R Therap Adv Gastroenterol. 2023; 16:17562848231180047.

PMID: 37485492 PMC: 10357067. DOI: 10.1177/17562848231180047.

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