Lumen-apposing stents versus plastic stents in the management of pancreatic pseudocysts: A large, comparative, international, multicenter study

Juliana Yang, Yen I. Chen, Shai Friedland, Ian Holmes, Christopher Paiji, Ryan Law, Amy Hosmer, Tyler Stevens, Franco Matheus, Rishi Pawa, Nihar Mathur, Divyesh Sejpal, Sumant Inamdar, Tyler M. Berzin, Christopher J. Dimaio, Sanchit Gupta, Patrick S. Yachimski, Andrea Anderloni, Alessandro Repici, Theodore JamesLaith H. Jamil, Mel Ona, Simon K. Lo, Srinivas Gaddam, Markus Dollhopf, Nuha Alammar, Eugenie Shieh, Majidah Bukhari, Vivek Kumbhari, Vikesh Singh, Olaya Brewer, Omid Sanaei, Lea Fayad, Saowanee Ngamruengphong, Eun Ji Shin, Todd H. Baron, Mouen A. Khashab

Research output: Contribution to journalArticle

Abstract

Background Larger caliber lumen-apposing stents (LAMSs) have been increasingly used in the management of pancreatic fluid collections, specifically when solid debris is present; however, their advantages over smaller caliber plastic stents in the management of pancreatic pseudocysts are unclear. The aim of this study was to investigate the safety and efficacy of LAMS specifically in the management of pancreatic pseudocysts compared with double-pigtail plastic stents (DPPSs). Methods We performed a multicenter, international, retrospective study between January 2012 and August 2016. A total of 205 patients with a diagnosis of pancreatic pseudocysts were included, 80 patients received LAMSs and 125 received DPPSs. Measured outcomes included clinical success, technical success, adverse events, stent dysfunction, pancreatic pseudocyst recurrence, and need for surgery. Results Technical success was similar between the LAMS and the DPPS groups (97.5 % vs. 99.2 %; P = 0.32). Clinical success was higher for LAMSs than for DPPSs (96.3 % vs. 87.2 %; P = 0.03). While the need for surgery was similar between the two groups (1.3 % vs. 4.9 %, respectively; P = 0.17), the use of percutaneous drainage was significantly lower in the LAMS group (1.3 % vs. 8.8 %; P = 0.03). At 6-month follow-up, the recurrence rate was similar between the groups (6.7 % vs 18.8 %, respectively; P = 0.12). The rate of adverse events was significantly higher in the DPPS group (7.5 % vs. 17.6 %; P = 0.04). There was no difference in post-procedure mean length of hospital stay (6.3 days [standard deviation 27.9] vs. 3.7 days [5.7]; P = 0.31). Conclusion When compared to DPPSs, LAMSs are a safe, feasible, and effective modality for the treatment of pancreatic pseudocysts and are associated with a higher rate of clinical success, shorter procedure time, less need for percutaneous interventions, and a lower overall rate of adverse events.

Original languageEnglish (US)
Pages (from-to)1035-1043
Number of pages9
JournalEndoscopy
Volume51
Issue number11
DOIs
StatePublished - Jan 1 2019

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ASJC Scopus subject areas

  • Gastroenterology

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Yang, J., Chen, Y. I., Friedland, S., Holmes, I., Paiji, C., Law, R., Hosmer, A., Stevens, T., Matheus, F., Pawa, R., Mathur, N., Sejpal, D., Inamdar, S., Berzin, T. M., Dimaio, C. J., Gupta, S., Yachimski, P. S., Anderloni, A., Repici, A., ... Khashab, M. A. (2019). Lumen-apposing stents versus plastic stents in the management of pancreatic pseudocysts: A large, comparative, international, multicenter study. Endoscopy, 51(11), 1035-1043. https://doi.org/10.1055/a-0759-1353